BC Advantage - 2026 Issue 5

Modifier 25: The Drama Never Ends

Modifier 25 is used when documentation supports a “significant, separately identifiable evaluation and management (E/M) service by the same physician or other qualified healthcare professional on the same day of a procedure or other service.” It seems straightforward, so why is there so much drama surrounding its usage? It has been around for decades; by now, we should be pros at applying it.   Currently, many large organizations are allowing providers to code their own clinic visits rather than staffing a dedicated department to code those services. This shift has changed the coder's responsibilities; they are now...

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