Confused about which modifier should be used to report an evaluation and management (E/M) service and a procedure that are performed on the same day of service? Should the E/M service be reported with modifier 25 or 57? Or should the procedure be reported with modifier 59? On one hand, a significant, separately identifiable service was performed with a procedure. On the other hand, the decision to perform the procedure was made during the E/M visit and/or a distinct service was performed.

Current Procedural Terminology (CPT®) has specific guidelines for the use of each modifier. However, not all payers recognize modifiers or follow CPT guidelines. The Centers for Medicare & Medicaid Services (CMS) has its own policies addressing the use of some modifiers. Many commercial payers will follow CMS guidelines or have their own. It is important to understand the CPT requirements and know your payer policies.


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