What is indicated by using Modifier 25?

The use of Modifier 25 indicates that a significant, separately identifiable evaluation and management (E/M) service was provided on the same day as a procedure or other service. When a healthcare provider performs an E/M service that is distinct from a procedure done during the same patient encounter, Modifier 25 is applied to highlight that the E/M service was indeed warranted and not bundled into the procedure.

This modifier allows for the appropriate reimbursement of the E/M service, signifying that the provider made a separate, medically necessary decision distinct from the procedure itself. It is essential for accurately reflecting the care provided and ensuring that each component is suitably documented and billed for.

In contrast, the other options pertain to different situations in coding: a bilateral procedure involves both sides of the body (thus requiring a different modifier), a global surgical package bundles surgical services and related pre- and post-operative care and would not utilize Modifier 25, and a repeat procedure on the same day uses a different modifier to indicate that a procedure was repeated rather than highlighting an additional E/M service.