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Don't be too hard on your modifier 25 use A certain doctor in our clinic said you don't require different diagnosis codes to use modifier 25 for reporting an evaluation & management service on the same date as a procedure. But then I have always added modifier 25 to the evaluation & management when I bill more than one procedure, pointing the primary diagnosis to the evaluation/management and a secondary diagnosis to the other procedure. How should one go about this situation? Well, you do not need to use a different diagnosis code in order to use modifier 25 (Significant, separately identifiable evaluation & management (E/M) service by the same doctor on the same day of the procedure or other service). Attaching the different diagnosis codes to the evaluation & management and the procedure does not necessarily support a separately reportable evaluation & management service. Your key to separately reporting the E/M service lies in whether your physician carried out and documented work beyond what's thought of as part of the procedure. In a nutshell, while using modifier 25, the diagnosis associated with the evaluation & management service can be the same or different from the diagnosis associated with the same-day procedure. According to the CPT manual description of modifier 25, "The evaluation & management service may be prompted by the symptom or condition for which the procedure and/or service was given. Therefore, different diagnoses aren't required for reporting of the evaluation and management on the same date." Important: Your gastroenterologist's documentation should establish clearly that the evaluation & management involved work over and above that normally associated with the procedure, and the encounter's only purpose was not to carry out the procedure. For further details on this and for other specialty-specific articles to assist your gastroenterology coding, sign up for a medical good coding resource like Coding Institute.
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