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, Dr. Jones provided an additional evaluation and management service (changing the patient's medications and ordering lab work) that was significant and separately identifiable from the preventive visit, making modifier 25 the correct choice to ensure reimbursement for both services.

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