Countdown to 2021: Know if the New E/M Rules Will Affect Modifier 25 Use Next Year

Why This Topic Matters

Correctly recognizing when a separate evaluation and management service exists can affect compliance and reporting accuracy. The article helps readers evaluate how the 2021 E/M framework may influence documentation review for minor-procedure encounters.

Article Sections

1. Remember Built-In Surgical E/M Component

   This section reviews the concept that procedures include some inherent evaluation and management work. It frames the discussion around same-day reporting and the relationship between minor procedures and separate E/M services.

2. Case 1: MDM-Based 99214 With Modifier 25

   This scenario describes an office encounter involving a musculoskeletal complaint and additional workup considerations. It shows how the 2021 E/M framework and documentation context are discussed in relation to a separate visit and a minor procedure.

3. Case 2: No Separate MDM-Based 99214 With Modifier 25

   This scenario presents a more ambiguous encounter involving a flare-up, imaging, and treatment on the same day. It focuses on why documentation may or may not support a distinct E/M service alongside the procedure.