A physician sees an established patient for a scheduled follow-up on hypertension, and during the same visit identifies and treats a separate, unrelated acute problem requiring a significant additional evaluation. To properly bill an E/M code in addition to the follow-up visit code, which modifier should be appended to the E/M code?
- AModifier -24
- BModifier -25
- CModifier -59
- DModifier -76
Show answer & explanationAnswer & explanation
Correct answer: B. Modifier -25
Modifier -25 indicates a 'significant, separately identifiable evaluation and management service' provided by the same physician on the same day as another procedure or service, which allows the E/M service to be billed separately when a distinct, additional problem is addressed. Modifier -24 applies to unrelated E/M services during a postoperative period, -59 indicates distinct procedural services (not typically E/M), and -76 indicates a repeat procedure by the same physician.
Why the other options are wrong
- A. Modifier -24 is used for unrelated E/M services during a global surgical postoperative period.
- C. Modifier -59 is used to indicate distinct procedural services, typically not paired with E/M codes.
- D. Modifier -76 indicates a procedure was repeated by the same physician, unrelated to this scenario.
Modifier -25
A CPT modifier appended to an E/M code to indicate a significant, separately identifiable evaluation and management service was performed by the same provider on the same day as another procedure or service.
- Allows separate billing of E/M when a distinct problem is addressed
- Commonly used when a minor procedure and an unrelated problem are both addressed in one visit
- Different from modifier -24 (postoperative unrelated E/M) and -59 (distinct procedural service)
Memory trick: 25 = 'two-for-one' visit, separate issue billed separately