A patient is seen in the provider's outpatient office for an annual physical exam. A comprehensive history, a detailed exam, and a moderate medical decision making is performed. Several of the patient's existing conditions are discussed and updates are noted. While in the office, the patient receives an immunization that is due as prescribed by CDC standards. Which modifier is appended to the Evaluation and Management code for this date of service?

Question

Quizplus · Accepted Answer

Modifier 25 is used to indicate that on the day of a procedure or service identified by a CPT code, the patient's condition required a significant, separately identifiable E/M service above and beyond the other service provided or beyond the usual preoperative and postoperative care associated with the procedure that was performed. In this scenario, the patient received an immunization in addition to the annual physical exam, which would require the use of Modifier 25 to bill for the E/M service separately from the immunization service.

A Patient Is Seen in the Provider's Outpatient Office for an Annual