Are You Using Modifier 25 Correctly?

Modifier 25 is one of the most frequently used — and most frequently audited — modifiers in family medicine.

It applies when a significant, separately identifiable E/M service is performed on the same day as a procedure.

Common mistake: Attaching modifier 25 to every preventive visit with a problem addressed. It's appropriate — but the documentation has to hold up.

What auditors look for:

• ✔ Separate documentation for the E/M and the procedure
• ✔ Medical necessity clearly documented for both
• ✔ The E/M goes above and beyond the pre/post-service work of the procedure

One audit finding can cost more than years of clean claims earned. Get the modifier right.