ICD-10, CPT, HCPCS, E/M, Abstract, Medical Terminology, Structure and Function, Pathophysiology, Public Speaking, Educating, Research and Development
Practicode Strategy #13- Modifier 25 (I saw this one A LOT) According to CPT guidelines (defined as one with a 0-day or 10-day global period), use Modifier 25 if * the physician perform and document the level of medical decision making or total time necessary to report a problem-oriented office or other outpatient E/M service for the complaint or problem? * the work to address the complaint or problem stand alone as a reportable service * the physician perform extra work that went above and beyond the typical pre- or postoperative work associated with the procedure code? Here is the plain and simple on Modifier 25. Modifier 25 is used when a minor procedure is performed during an encounter that has an E/M Component. Here are the questions I asked to guide me. 1. Was there an E/M encounter? -yes or no 2. Was there a minor procedure performed? Yes or no 3. Was the E/M encounter and minor procedure done on the same day by the same physician during the SAME encounter? yes or no 4. If the answer is yes to the questions above, append Modifier 25 to the E/M code . Here are some minor procedures I was given and Modifier 25 was needed. -injections -EKG/ECG -X Rays -Cath/Urinalysis -Pacemaker Interrogation -Treatment of warts -fingernail removed due to a crushed finger Applying understanding I have to understand the "why" to modifiers so my brain can tuck it away in the correct file. So here is the "why". An E/M component is automatically embedded in a minor procedure because the physician has to address the need, risk, and patient's overall health before performing the minor procedure. We use modifier 25 so the physician gets PAID FOR BOTH the E/M and the procedure. Disclaimer- Please research and cross reference all codes and modifiers. Each case is different and unique. *****QUESTION FOR SEASONED CODERS****** There is one case where a new patient saw a Cardiologist and had an EKG performed, labs drawn, and was monitored and Modifier 25 was not appended for the EKG. Is it because it was done by a Cardiologist and the EKG wasn't considered going above and beyond scope of service?
Catherine Keen
7mo
Thank you for posting as I have just purchased practi code and it seems daunting but I know I will learn so much from it and even more from this amazing community I have been lucky enough to find.
CRC pending / 2025 Incoming Richardson AAPC Chapter Secretary
7moMy brain works the same way, understanding the WHY is important. I'm currently working my way through Practicode and love the challenge, but just just starting out can be overwhelming.