Medical Auditing Practice Exam

When should modifier 25 not be used?

1. When a procedure does not change the code definition.

2. When a significant service is provided during a procedure.

3. When there is no additional, identifiable service performed.

4. When the procedure requires specific documentation.

The correct answer is: When there is no additional, identifiable service performed.

Modifier 25 is used to indicate that a significant, separately identifiable evaluation and management (E/M) service was provided by the same physician on the same day as another procedure. It is essential to use this modifier only under the right circumstances, where there is a clear distinction between the services rendered. The correct response highlights that modifier 25 should not be used when there is no additional, identifiable service performed. This is crucial because if no separate E/M service is provided, then there is no justification for adding this modifier. In such cases, the documentation wouldn't support the claim that a significant, separate service was performed alongside the procedure. For example, if a physician only performed a procedure without separately assessing the patient's condition or providing additional management, then there is no basis for modifier 25. It is important for medical coders and auditors to not misuse modifier 25, as this can lead to compliance issues and potential denials from payers. In contrast, the other options outline scenarios where the use of modifier 25 may still be appropriate or relevant. The first option suggests a situation involving code definitions, which doesn't directly pertain to the necessity of modifier 25. The second one implies that a significant service was rendered, which aligns with the very