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Use Modifier 25 When: E/M is on same day as a minor procedure (0 or 10-day global) The E/M addresses a clinical problem beyond the procedure’s standard pre/post care Documentation supports a separately identifiable E/M with its own MDM or total time The patient could have been seen just for that E/M problem alone Do NOT Use Modifier 25 When: The E/M was only to assess the problem being treated by the procedure The patient came only for the procedure with no other clinical concerns The “separate” problem is a complication of the same condition Being a “new patient” is not a reason to use modifier 25

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