Certified Medical Assistant (CMA AAMA)Administrative: Billing, Coding and SchedulingMedium
A medical assistant is processing a claim for a patient who received an influenza vaccination. The patient also had an office visit for a chronic condition on the same day. Which CPT modifier should be considered when billing for both services to indicate they are distinct?
- AModifier -25
- BModifier -24
- CModifier -59
- DModifier -51
Show answer & explanationAnswer & explanation
Correct answer: A. Modifier -25
Modifier -25 indicates that a significant, separately identifiable evaluation and management (E/M) service was performed by the same physician on the same day of a procedure or other service. In this case, the office visit for a chronic condition is distinct from the influenza vaccination.
Why the other options are wrong
- B. Modifier -24 (Unrelated E/M service by the same physician during a post-operative period) is not applicable here.
- C. Modifier -59 (Distinct Procedural Service) is used to indicate that a procedure or service was distinct or independent from other non-E/M services performed on the same day.
- D. Modifier -51 (Multiple Procedures) is used for multiple surgical procedures, not typically E/M with a vaccine.
Modifier -25
A CPT modifier used to indicate that a physician performed a significant, separately identifiable evaluation and management (E/M) service on the same day as a procedure or other service.
- Applies to E/M services.
- Requires the E/M service to be distinct from the other procedure/service.
- Prevents automatic bundling of the E/M service with the procedure.
Memory trick: Modifier -25: Separate E/M, distinct and significant, on the very same day!