Here are three brief descriptions of when to properly use Modifier 25. Modifier 25 is the most common modifier used in an office based Medical practice and below are some easy to follow guidelines to reduce denials and improve collections. There are many great billing systems that have tables loaded which assist in using modifiers but you should never rely on technology (solely) when it comes to billing properly.
1. You have a different diagnosis for the E/M and the procedure. The two diagnoses may be related – such as when the diagnosis with the E/M is a sign or symptom and the diagnosis with the procedure more definitive. In this case, the E/M resulted in a decision to perform the procedure, either diagnostic or therapeutic.
