A 50-year-old male patient presents to the office today for his annual preventive visit. During the visit, Dr. Jones becomes concerned about the patient's hypertension and believes that this needs some evaluation and management beyond the preventive visit. Dr. Jones changes the patient's medications and orders lab work. Which modifier would be reported to the payer in order to be reimbursed for both the preventive visit and the office visit?

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 management of the patient's hypertension during a preventive visit qualifies for the use of modifier 25, allowing for reimbursement for both the preventive visit and the additional office visit for hypertension management.

A 50-Year-Old Male Patient Presents to the Office Today for His