{"id":20653,"date":"2019-01-03T10:12:12","date_gmt":"2019-01-03T15:12:12","guid":{"rendered":"http:\/\/www.carecloud.com\/continuum\/?p=20653"},"modified":"2019-01-03T10:12:12","modified_gmt":"2019-01-03T15:12:12","slug":"http-www-carecloud-com-continuum-procedure-coding-25-modifier","status":"publish","type":"post","link":"https:\/\/carecloud.com\/continuum\/http-www-carecloud-com-continuum-procedure-coding-25-modifier\/","title":{"rendered":"Procedure Coding: When to Use the 25 Modifier"},"content":{"rendered":"<h2>PROCEDURE CODING: WHEN TO USE THE MODIFIER 25<\/h2>\n<p><span data-contrast=\"auto\">Modifiers provide payers detailed information about what a doctor did while working with their patient. Modifiers play a crucial role in demonstrating the required medical decision-making (MDM) that a physician must show to bill and get paid for all services provided. This article is about modifier 25 and its application in different circumstances.<\/span><span data-ccp-props=\"{&quot;134233117&quot;:false,&quot;134233118&quot;:false,&quot;335559738&quot;:240,&quot;335559739&quot;:240}\">\u00a0<\/span><\/p>\n<h2><b><span data-contrast=\"auto\">DEFINING MODIFIER 25<\/span><\/b><\/h2>\n<p><span data-contrast=\"auto\">Modifier 25 indicates that a patient&#8217;s condition requires a distinct and substantial evaluation and management (E\/M) service, separate from any other procedures or services performed on the same day by the same physician or healthcare provider. It helps to distinguish an E\/M service that is significant enough to be billed separately from other procedures that may have been conducted during the same visit.<\/span><\/p>\n<h3>CLINICAL SCENARIOS<\/h3>\n<p><span data-contrast=\"auto\">Here are three instances where it is suitable to use <a href=\"https:\/\/www.carecloud.com\/continuum\/procedure-coding-25-modifier\/\">modifier 25<\/a> for coding the services of a provider:<\/span><\/p>\n<h3>\u00a0EXAMPLE ONE:<\/h3>\n<p><span data-contrast=\"auto\">During an examination, a clinician stumbles on a suspicious skin lesion. After due deliberation, he concluded it needed a punch biopsy. The E\/M would be a separately identifiable service (updating patient history from the past year, skin exam of moderate-high complexity, and MDM) from the biopsy procedure.<\/span><\/p>\n<h3>EXAMPLE TWO:<\/h3>\n<p><span data-contrast=\"auto\">A patient enters her OBGYN&#8217;s office and complains of unusual recent bleeding and pain. However, no clear cause is identified even after a pelvic exam and routine PAP smear. The <a href=\"https:\/\/www.carecloud.com\/continuum\/basics-of-ob-gyn-coding-guidelines\/\">OBGYN<\/a> finds it necessary to carry out a pelvic ultrasound to investigate the issue precisely. Modifier 25 applies here as the ultrasound procedure was used to diagnose an abnormality.<\/span><\/p>\n<h3>EXAMPLE THREE:<\/h3>\n<p><span data-contrast=\"auto\">A man goes to see a cardiologist and reports chest pain while doing physical activity. The patient had experienced hypertension in the past, though it was under control with medication. Post E\/M from a physician: The patient needs a Cardiovascular stress test. The same day, this test was done by the same doctor who had done the E\/M earlier.<\/span><\/p>\n<p><span data-contrast=\"auto\">If the E\/M is not bundled into the stress test, then the Cardiologist&#8217;s coder can use modifier 25 to indicate that these two services were separate and significant: 99213-25, 93015.<\/span><\/p>\n<h3>USE OF MODIFIER 25<\/h3>\n<p><span data-contrast=\"auto\">Like any other provider of service billing, the point about needing to justify services performed is significant here, too. When using modifier 25, physicians must provide clear and detailed documentation to back up the MDM involved in the treatment given.<\/span><\/p>\n<p><span data-contrast=\"auto\">The provider&#8217;s thought process needs to be seen in the required documentation, as it will play an essential part; without a complete medical record, payers could keep making decisions like wrong <a href=\"https:\/\/www.carecloud.com\/continuum\/how-to-handle-insurance-claim-denials\/\">claim denials<\/a> or paying too little. If there is proper support paperwork, the doctor&#8217;s billing staff can fight back by submitting claims reconsiderations even though the payer wrongly denies services.<\/span><\/p>\n<h4>CONCLUSION<\/h4>\n<p><span data-contrast=\"auto\">Understanding modifier 25 and using it appropriately is significant to file accurate claims, leading to proper payment. Applying modifier 25 allows us to code physician services correctly and guarantees that they are paid for as such. However, it is not entirely true that coding and reimbursement rely solely on modifier 25; physicians must sufficiently document why E\/M services were needed apart from the procedure\/s done later. Doctors and their coding and billing teams must collaborate effectively to generate the most transparent and precise E\/M claims backed by correct medical records.<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"<p>PROCEDURE CODING: WHEN TO USE THE MODIFIER 25 Modifiers provide payers detailed information about what a doctor did while working with their patient. Modifiers play a crucial role in demonstrating the required medical decision-making (MDM) that a physician must show to bill and get paid for all services provided. This article is about modifier 25 [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":31834,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[542,389],"tags":[],"class_list":["post-20653","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-cpt-codes","category-resources"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.3 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Modifier 25 in Procedure Coding<\/title>\n<meta name=\"description\" content=\"Learn about Modifier 25 in procedure coding. Discover when to use it for separate, distinct evaluation and management services.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/carecloud.com\/continuum\/http-www-carecloud-com-continuum-procedure-coding-25-modifier\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Modifier 25 in Procedure Coding\" \/>\n<meta property=\"og:description\" content=\"modifier 25 is a particularly meaningful coding tool for physicians who bill for evaluation and management (E\/M) services\" \/>\n<meta property=\"og:url\" content=\"https:\/\/carecloud.com\/continuum\/http-www-carecloud-com-continuum-procedure-coding-25-modifier\/\" \/>\n<meta property=\"og:site_name\" content=\"Continuum\" \/>\n<meta property=\"article:published_time\" content=\"2019-01-03T15:12:12+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/carecloud.com\/continuum\/wp-content\/uploads\/2019\/01\/modifier-25-banner-1.png\" \/>\n\t<meta property=\"og:image:width\" content=\"1440\" \/>\n\t<meta property=\"og:image:height\" content=\"600\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/png\" \/>\n<meta name=\"author\" content=\"cc_continuum\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"cc_continuum\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"3 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\\\/\\\/carecloud.com\\\/continuum\\\/http-www-carecloud-com-continuum-procedure-coding-25-modifier\\\/#article\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/carecloud.com\\\/continuum\\\/http-www-carecloud-com-continuum-procedure-coding-25-modifier\\\/\"},\"author\":{\"name\":\"cc_continuum\",\"@id\":\"https:\\\/\\\/carecloud.com\\\/continuum\\\/#\\\/schema\\\/person\\\/6af17e75a684cc5cd23741e014351348\"},\"headline\":\"Procedure Coding: When to Use the 25 Modifier\",\"datePublished\":\"2019-01-03T15:12:12+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\\\/\\\/carecloud.com\\\/continuum\\\/http-www-carecloud-com-continuum-procedure-coding-25-modifier\\\/\"},\"wordCount\":553,\"commentCount\":0,\"publisher\":{\"@id\":\"https:\\\/\\\/carecloud.com\\\/continuum\\\/#organization\"},\"image\":{\"@id\":\"https:\\\/\\\/carecloud.com\\\/continuum\\\/http-www-carecloud-com-continuum-procedure-coding-25-modifier\\\/#primaryimage\"},\"thumbnailUrl\":\"https:\\\/\\\/carecloud.com\\\/continuum\\\/wp-content\\\/uploads\\\/2019\\\/01\\\/modifier-25-banner-1.png\",\"articleSection\":[\"CPT Codes\",\"Resources\"],\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"CommentAction\",\"name\":\"Comment\",\"target\":[\"https:\\\/\\\/carecloud.com\\\/continuum\\\/http-www-carecloud-com-continuum-procedure-coding-25-modifier\\\/#respond\"]}]},{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/carecloud.com\\\/continuum\\\/http-www-carecloud-com-continuum-procedure-coding-25-modifier\\\/\",\"url\":\"https:\\\/\\\/carecloud.com\\\/continuum\\\/http-www-carecloud-com-continuum-procedure-coding-25-modifier\\\/\",\"name\":\"Modifier 25 in Procedure Coding\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/carecloud.com\\\/continuum\\\/#website\"},\"primaryImageOfPage\":{\"@id\":\"https:\\\/\\\/carecloud.com\\\/continuum\\\/http-www-carecloud-com-continuum-procedure-coding-25-modifier\\\/#primaryimage\"},\"image\":{\"@id\":\"https:\\\/\\\/carecloud.com\\\/continuum\\\/http-www-carecloud-com-continuum-procedure-coding-25-modifier\\\/#primaryimage\"},\"thumbnailUrl\":\"https:\\\/\\\/carecloud.com\\\/continuum\\\/wp-content\\\/uploads\\\/2019\\\/01\\\/modifier-25-banner-1.png\",\"datePublished\":\"2019-01-03T15:12:12+00:00\",\"description\":\"Learn about Modifier 25 in procedure coding. 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