Magical Modifier 25

Modifier 25 is a medical billing code used to indicate extra work for a medical service or procedure. There are three simple steps you can use to learn how to correctly use the medical billing modifier 25.

The first medical billing step to correctly use modifier 25 is to only report the most significant services provided during the visit. When reporting an Evaluation and Management exam, it is very difficult to perform a service that is separately billable. Most things are covered under the evaluation and management, including injections and tests. In order to correctly append the medical billing modifier to a procedure, it must be very significant.

The next step to correctly append modifier 25 in medical billing is to remember to separately document the Evaluation and Management session. To clearly show a payer that the E/M visit is completely separate from another procedure, you should document them on separate papers. Both pieces of documentation should be included in your medical billing claim.

The third surefire way to correctly append modifier 25 is to use the correct diagnosis code for the Evaluation and Management. Always using descriptive diagnosis codes with your medical billing is a must. Without this information, the payers have no idea why you charged for different services separately. Don’t leave your payers in the dark. Just by following these three steps can dramatically improve your modifier 25 use in medical billing.

View all Articles by: Melissa Clark, CCS-P