Understanding Modifier 25 and Modifier 57 in medical billing and coding

Effective medical billing and coding are essential for accurate reimbursement in medical practices. Two commonly used modifiers, Modifier 25 and Modifier 57, play a crucial role in indicating distinct services and decision-making processes.  

Modifier 25 

Use Modifier 25 to signify that a significant, separately identifiable evaluation and management (E/M) service was performed by the same healthcare provider on the same day as another procedure or service. Procedures with a 0- or 10-day global period can be separately reported by using Modifier 25, assuming the E/M service is significant and separately identifiable. When the patient presents with the knowledge that the procedure is going to be done and no other conditions are addressed, the E/M is typically not supported, and Modifier 25 cannot be used. Below are a few scenarios for when to use Modifier 25: