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When to Use of modifier 25
Modifier 25 should only be used when a conjunction procedure has ‘S’ or ‘T’ indicator along with significantly identifiable E&M service. Mostly X ray, CT without contrast, IV infusion, injection, IM (intramuscular) is very common with E&M codes. So, procedures with ‘S’ or ‘T’ status indicator along with E&M service, modifier 25 should be appended with E&M CPT code.
Modifier 25 (significant, separately identifiable evaluation and management [E/M] service by the same physician on the same day of the procedure or other service)
Read also: new X {EPSU} modifier in place of 59 modifier
When to use 27 modifier
Modifier 27 is used when a patient has multiple visits on same day, by same or different physician for an E&M service. The documentation should be supported to code Modifier 27. If a patient comes with ED physician in morning and again visit the same or different physician in afternoon, the next E&M visit code will be appended with modifier 27. Do use modifier 25 also if any conjunction procedure is performed with status modifier ‘S’ or ‘T”. We can use both modifier 25 and 27 together.
Use modifier -27 for multiple outpatient hospital evaluation and management (E/M) encounters on the same date. Use this modifier when a patient receives multiple E/M services performed by the same or different physicians in multiple outpatient hospital settings (e.g., emergency department, clinic, etc.)
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