Understanding When to Use Modifier -25

There has been much confusion over the use of CPT modifier -25. What follows for a "definition" is what I was able to deduce from some internet sites that addressed this modifier.  I think the information is accurate.  In general most 3rd party payers assume the inclusion of a low level office visit as a component of most procedures (OCT, VG, etc.).  Therefore, an office visit coded without a -25 modifier may be rejected even if the office visit had nothing to do with the technical or professional components of the procedure itself.  However, using a -25 modifier when the components of the office visit had nothing to do with the procedure will generally get you paid. As you can never tell what a third party is going to do in rejecting of accepting a claim you should have your TPA make you aware of ANY rejected claims so that you can adjust as necessary.  Happy coding.

Understanding When to Use Modifier -25