Following are some common mistakes pediatric practices make when reporting modifiers with Current Procedural Terminology (CPT®) evaluation and management (E/M) service and procedure codes.

Reporting an E/M service with modifier 25 for an insignificant problem that was encountered during a preventive medicine visit

When a problem or abnormality is addressed at the time of a preventive medicine visit (99381–99385 or 99391–99395), it may be reported using an office or other outpatient service code (99201–99215) in addition to the preventive medicine service code only if it is not an insignificant problem (eg, stable chronic problem), it requires significant additional work (eg, symptomatic atopic dermatitis, migraine headache) to perform the required key components (history, physical examination, and medical decision-making, or time if more than 50% of the face-to-face encounter is spent in counseling or coordination of care), and it is supported by medical record documentation of...

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