Why is modifier 25 used

Modifier 25 can be used in other situations such as with critical care codes and emergency department visits. For further information email your questions to coding acc.

Here is an example of an appropriate use of Modifier Example 1: A patient visits the cardiologist for an appointment complaining of occasional chest discomfort during exercise. Some Examples of When Not to Use the Modifier 25 Do not use a 25 Modifier when billing for services performed during a postoperative period if related to the previous surgery.

See example 2. Patient came in for a scheduled procedure only Example 2: When a patient is scheduled to come into your office for a cardiovascular stress test and the physician also completes a history and performs a limited examination specifically related for the stress test your office should only code for the cardiovascular stress test A dermatologist examines an established patient during a regularly scheduled skin check and performs a head-to-toe skin exam.

The physician determines this should be biopsied and performs a punch biopsy. A woman comes into her OBGYN office for an appointment and reports to her physician that she has recently experienced abnormal bleeding and pain. However, after a pelvic exam and regular PAP smear are conducted, these reported symptoms do not appear to have an obvious cause.

A patient visits his cardiologist and presents with a complaint of chest pain during physical exertion. This patient has a personal history of high blood pressure controlled with medication. As with all matters of provider service billing, understanding the necessity of justification of services performed is mandatory.

These services are separate and significant and not part of the preoperative services for the lesion removal. The patient presents with a head laceration, and you also examine the patient for neurological damage before repairing the laceration. Separate diagnoses would not be necessary. Be sure to have your staff appeal any denied or bundled claims.

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Felger teaches family medicine at St. Marie Felger is a medical coding consultant and certified professional coder. Send comments to fpmedit aafp.

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