AMA CPT® Assistant - 1998 Issue 9 (September)
Appropriate Use of Modifier -25 (September 1998)
September 1998 pages 4-6 Coding Communication Appropriate Use of Modifier -25 Modifier -25, Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of a Procedure or Other Service The physician may need to indicate that on the day a procedure or service identified by a CPT code was performed, the patient's condition required a significant, separately identifiable E/M service above and beyond the other service provided or beyond the usual preoperative and postoperative care associated with the procedure that was performed. This circumstance may be reported by adding the modifier -25 to the...
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Article Overview
This CPT Assistant article reviews the purpose and historical context of modifier -25 and discusses how it fits into documentation and claim reporting for evaluation and management services performed on the same day as another procedure or service. It also touches on Medicare audit interest, general modifier reporting concepts, related AMA/CPT references, and the need for documentation support across multiple E/M service categories. The article is relevant to physicians, coders, auditors, compliance staff, and billing professionals who work with CPT and Medicare Part B claims.
Why This Topic Matters
Modifier -25 is commonly scrutinized in coding and audit settings, so understanding the scope of the article helps readers evaluate whether it addresses their documentation, compliance, or claim-editing needs without exposing the premium content itself.
Article Sections
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September 1998 pages 4-6
Publication information and introductory coding communication context for the article.
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Appropriate Use of Modifier -25
Overview of the modifier, its purpose in reporting same-day evaluation and management services, and the general context for its use.
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Modifier -25: Appropriate Use
Discussion of audit interest, Medicare-related concerns, and the broader rationale for reviewing modifier use.
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Looking Back
Historical background on modifier development and references to CPT and Federal Register updates.
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How to Use Modifiers
General reporting mechanics for modifiers and a broad list of E/M service categories referenced in the article.
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Global Surgical Package
Comparison of modifier use with global surgical package concepts and examples involving procedures and evaluation and management services.
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Modifier -25 Continued
Additional guidance themes on documentation, payer differences, and compliance-oriented practices for modifier review.
What You Will Learn
- The historical and policy context behind modifier -25
- How the article frames same-day evaluation and management reporting
- Which broad E/M service categories are discussed in relation to modifier use
- How the article connects modifier use with Medicare, CPT, and compliance topics
- Why documentation and audit review are emphasized in relation to modifier reporting
Who Should Read This
- Physicians
- Medical coders
- Billing staff
- Compliance officers
- Practice managers
- Auditors
- Consultants
Codes Discussed
Code Ranges Discussed
Modifiers Discussed
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