Coding Spotlight: Modifier -25 VS -59
When coding CPT, these two modifiers, -25 and -59, can often be confusing. While both modifiers address situations where multiple services are performed on the same day, they serve distinct purposes, so let's break it down:
Modifier -25 (Significant, Separately Identifiable E/M Service by the Same Physician on the Same Day of a Procedure or Other Service)
Used for an E/M service that's separate and significant from a procedure on the same day. Think: a patient comes in for a scheduled injection, but also has an unexpected, detailed evaluation of a new problem. The E/M is the key here. It must be separately identifiable and documented.
Modifier -59 (Distinct Procedural Service)
Used when procedures or services are distinct or independent from each other. This is about the procedure being separate, not an E/M. Often used when procedures are done at different sites, during different sessions, or are distinct procedures on the same site.
Key Takeaway:
-25 is about a separate E/M, -59 is about separate procedures.
Essentially, ask yourself: 'Is there a separate, significant E/M service being performed?' If yes, -25 might be appropriate. If the question is, 'Are the procedures themselves distinct?' then -59 is likely the answer.
Here are some additional resources regarding modifiers:
When To Use A Modifier in Medical Coding
Modifier 25 Usage in Medical Coding
Use and Abuse of Modifier 59 - Did You Know CCO #036
When coding CPT, these two modifiers, -25 and -59, can often be confusing. While both modifiers address situations where multiple services are performed on the same day, they serve distinct purposes, so let's break it down:
Modifier -25 (Significant, Separately Identifiable E/M Service by the Same Physician on the Same Day of a Procedure or Other Service)
Used for an E/M service that's separate and significant from a procedure on the same day. Think: a patient comes in for a scheduled injection, but also has an unexpected, detailed evaluation of a new problem. The E/M is the key here. It must be separately identifiable and documented.
Modifier -59 (Distinct Procedural Service)
Used when procedures or services are distinct or independent from each other. This is about the procedure being separate, not an E/M. Often used when procedures are done at different sites, during different sessions, or are distinct procedures on the same site.
Key Takeaway:
-25 is about a separate E/M, -59 is about separate procedures.
Essentially, ask yourself: 'Is there a separate, significant E/M service being performed?' If yes, -25 might be appropriate. If the question is, 'Are the procedures themselves distinct?' then -59 is likely the answer.
Here are some additional resources regarding modifiers:
When To Use A Modifier in Medical Coding
Modifier 25 Usage in Medical Coding
Use and Abuse of Modifier 59 - Did You Know CCO #036