Current Procedural Terminology (CPT®) and National Correct Coding Initiative (NCCI) edits often call for use of modifiers to designate that 2 services provided on the same date by the same individual or individuals of the same specialty and same group practice are appropriately reported. Two CPT modifiers that may be used to indicate a service is separately reportable based on clinical considerations are commonly confused. Modifiers 25 and 59 are not only confused by physicians and coders but often by payers and third-party claims administrators. This confusion can have considerable effect on whether a physician or other provider receives appropriate payment for all services rendered.

Understanding the different purposes of these modifiers is key to compliant coding. The CPT definitions of these modifiers are as follows:

Note that the italicized text in each definition is intended to make clear that a significant, separately identifiable E/M service is...

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