Certified Professional Coder (CPC) Practice Test

What is the purpose of the modifier -25 in an E/M service?

1. To indicate a bilateral procedure

2. To show a different diagnosis

3. To report a significant, separately identifiable service

4. To denote an emergency procedure

The correct answer is: To report a significant, separately identifiable service

The modifier -25 is specifically used to indicate that a significant, separately identifiable evaluation and management (E/M) service was provided by the healthcare provider on the same day as another procedure or service. When a provider sees a patient for a problem and also performs another procedure on that same day, modifier -25 helps clarify that the E/M service was not just a routine follow-up or part of the procedure, but a distinct service that warranted additional attention and billing. By attaching modifier -25 to the E/M code, the coder is communicating to insurers that the provider performed a comprehensive evaluation that was necessary for appropriate care, separate from any other procedures performed during the visit. This helps ensure that the provider is properly compensated for the additional work involved in managing the patient's condition during that encounter. This modifier is crucial for coding accuracy and for maximizing reimbursement while ensuring compliance with coding regulations. Understanding when and how to use modifier -25 correctly is an essential skill for any professional coder, particularly in the context of E/M services.