Modifiers
Modifier 25
Identifying significant and separate visits by the same physician on the same day of a minor surgical procedure or other service.
A physician may need to indicate that on the day he/she performed a minor procedure or service identified by a CPT code, the patient’s condition required a significant, separately identifiable E/M service beyond the other service provided or beyond the usual preoperative care associated with the procedure performed.
A minor procedure is defined as having a 0 or 10-day global period.
Mountain Health Co-Op recognizes modifier 25 ONLY if the medical record demonstrates appropriate documentation to specifically support BOTH the E/M and additional services as separately identifiable based on AMA CPT CCI coding guidelines.
Using modifier 25 on an E/M service indicates that documentation is available in the patient’s record to support billing the service as a significant and separately billable service unrelated to the procedure or original service(s) performed.
This documentation should be clearly distinct from the documentation related to the other procedure or service(s) performed on the same service date.