CPT 2006: Don't Use 25 Modifier Unless You Can Back It Up

Why This Topic Matters

These CPT updates affect how common evaluation and management services are reported and documented. The article helps readers understand which code families were changed, what documentation themes matter, and which new code groups were added for facility and oversight services.

Article Sections

1. Follow-up, confirmatory consultation codes deleted

   Covers the removal of certain consult code categories and the shift in how inpatient follow-up care is categorized in CPT 2006.

2. Billing implications for inpatient consultation and subsequent care

   Discusses the impact of the consult-code changes on inpatient stays and the general approach to reporting additional care during the same admission.

3. Clarification of modifier 25 documentation requirements

   Summarizes the update to modifier 25 language and the broader documentation emphasis for same-day evaluation and management services.

4. New nursing facility and care plan oversight codes

   Introduces new CPT code groups related to nursing facility care and oversight services in other care settings.