Certified Coding Specialist (CCS) Practice Exam

Modifier 25 indicates that a significant, separately identifiable evaluation and management (E/M) service was performed by the same physician on the same day as a procedure. This modifier is applied when a physician provides an E/M service that is distinct and separate from a procedure performed on the same day. It helps to clarify that the E/M service is not simply part of the procedure but warranted additional attention, indicating to payers that they should reimburse for both the E/M service and the procedure.

In situations where an E/M service is necessary to address a patient's condition before, after, or during the procedure, modifier 25 is essential. It ensures that the physician is compensated for the cognitive work and time spent with the patient, separate from the procedure performed.

Other options do not accurately capture the essence of modifier 25. For instance, a canceled procedure would not warrant modifier 25, as it applies specifically to distinct and identifiable services rendered. Similarly, additional follow-up care requirements do not directly relate to the issues addressed with modifier 25, and minor procedures do not typically warrant the same criteria that modifier 25 covers in terms of significant, separately identifiable services.