what is modifier 25 and 59 Q What is modifier 25 A As described by CPT Modifier 25 is used to denote a significant separately identifiable evaluation and management E M service by the same physician on the same day of the procedure or other service Modifier 25 should only be submitted on an E M code The
Current Procedural Terminology CPT defines modifier 25 as when a healthcare practitioner provides a significant and separately identifiable evaluation and management E M service above and beyond the other services provided by the same practitioner on the same day of the service CPT Manual defines modifier 59 as a Distinct Procedural Service The 59 modifier is considered the most misused modifier by coders It is normally used to indicate that two or more procedures were performed during the same visit to different sites on the body
what is modifier 25 and 59
what is modifier 25 and 59
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Modifier 26 Fact Sheet
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Know The Right Use Of Modifiers 51 And 59 Surgical Modifiers
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Modifier 59 is an important NCCI PTP associated modifier that physicians and providers often use incorrectly This fact sheet will help you use this modifier correctly Definition of Modifiers 59 XE XP XS XU The CPT Manual defines modifier 59 as Modifier 25 is used to indicate a significant and separately identifiable evaluation and management E M service by the same physician on the same day another procedure or service was performed
It is important for billing personnel to understand that a modifier is used to modify a procedure or service but is not intended to change the definition of the CPT code Appending a Modifier 25 or 59 to bypass edits can be risky business potentially causing an audit for noncompliance Modifier 25 is a way to identify a significant separately identifiable evaluation and management service by the same physician or other qualified health care
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What is Modifier 59 The definition of the 59 modifier per the CPT manual is as follows Modifier 59 Distinct Procedural Service Under certain circumstances the physician may need to indicate that a procedure or service was distinct or independent from other services performed on the same day Click here to Download Modifier 59 is used to identify procedures services other than E M services that are not normally reported together but are appropriate under the circumstances It is the most reported modifier that affects National Correct Coding Initiative NCCI processing
Modifier 25 is used to signify that when a separate identifiable evaluation and management E M service was performed which can refer to two evaluation and management E M services or a procedure plus an E M service Note this Modifier is not used to report an E M service that resulted in a decision to perform surgery see Modifier 57 For significant separately identifiable non E M services on the same day see Modifier 59 There are several nationally recognized sources of information on the Modifier 25
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what is modifier 25 and 59 - For example physicians shouldn t report a biopsy and excision of the same lesion using modifier 59 They should only report the removal says Clements An exception to this is when a physician biopsies the lesion waits for the pathology results and then excises the lesion during the same session