It is perhaps one of the most used and potentially misused modifiers. Modifier 25 indicates a significant and separately identifiable evaluation and management (E/M) service by the same physician or other qualified health care professional on the same day of a procedure or other service. Do you know when it is and is not appropriate to append modifier 25? Test your knowledge for each of the following scenarios.

Sarah is seen for a scheduled nurse visit to receive the third dose of human papillomavirus (HPV) vaccine. Sarah presents with complaint of an earache. Dr Bill is consulted and evaluates Sarah, diagnosing mild otitis externa. Documentation supports an expanded problem-focused history, expanded problem-focused examination, and straightforward medical decision-making (MDM). Nursing staff is instructed to provide the third dose of HPV vaccine as scheduled. The immunization is reported with codes 90471 (immunization administration [includes percutaneous, intradermal, subcutaneous, or intramuscular injections];...

You do not currently have access to this content.