Using modifier 25 with E&M service codes
Modifier 25 is used to describe a "
significant and separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service."
- This modifier is used only with evaluation and management (E&M) codes.
- The physician may need to indicate that the patient's condition required a service above and beyond what is expected for other services provided on the same day.
- Documentation within the medical record must support the level of E&M service reported.
- Do not use modifier 25 to report an E&M service that resulted in a decision to perform surgery (use modifier 57 instead).
- Notes are required when you resubmit a code with modifier 25.
