Medicare and commercial insurance audits of modifier 25.
Modifier 25 is being audited by Medicare and commercial Insurance companies. Modifier 25 should be used when a procedure and an E&M service happen on the same day. Generally, one cannot bill these two services as the office visit is included in the procedure code when they occur on the same day. However, if the evaluation and management service is significant and separately identifiable from the procedure, then the two can be billed together.
Medicare states that modifier 25:
Should be used when a significant, separately identifiable, and above and beyond the usual preoperative and postoperative care associated with the procedure;
Should not be used when a patient came in only for a scheduled procedure.