Medical Auditing Practice Exam

What scenario correctly exemplifies the use of modifier 25?

1. A patient receiving a routine follow-up without any additional complaints.

2. A patient who presents a chronic issue with no new complaints.

3. A patient undergoing a neurological exam due to a severe headache during a follow-up visit.

4. A patient who has multiple unrelated complaints presenting in the same visit.

The correct answer is: A patient undergoing a neurological exam due to a severe headache during a follow-up visit.

The scenario that exemplifies the use of modifier 25 involves a patient who is undergoing a neurological exam due to a severe headache during a follow-up visit. Modifier 25 is applied to indicate that a significant, separately identifiable evaluation and management service was provided on the same day as another procedure or service. In this case, the patient's severe headache represents a new, significant issue requiring a separate evaluation from the follow-up visit, justifying the use of modifier 25. Using this modifier allows for appropriate billing and coding by signaling to payers that two distinct services were rendered, ensuring that the provider is compensated for the additional work involved in the neurological assessment beyond the standard follow-up care.