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

Why This Topic Matters

The article helps readers understand whether common same-day E/M and procedure encounters still support separate reporting under the revised 2021 office and outpatient E/M approach. It is relevant for accurate documentation review, compliance, and claims processing.

Article Sections

1. Remember Built-In Surgical E/M Component

   This section reviews the general relationship between procedures and associated evaluation and management work. It also notes an unchanged same-day reporting principle involving major surgical global periods.

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

   This scenario presents a same-day office or outpatient encounter alongside a minor procedure and discusses why a separate E/M may be supportable under the 2021 framework. It highlights documentation themes tied to additional workup and assessment of a new problem.

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

   This scenario examines a different same-day encounter where the record may not clearly support an additional E/M service. It focuses on documentation ambiguity and why the separate service question may remain unresolved.