Scribd
Upload
19 views2 pages

EM Modifiers Detailed Examples

Uploaded by

Sujeera Hameed
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
19 views2 pages

EM Modifiers Detailed Examples

Uploaded by

Sujeera Hameed
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
You are on page 1/ 2

E/M Modifiers - Detailed Examples

Modifier 25

Significant, separately identifiable E/M service by the same physician on the same day of the

procedure or other service.

Example: A patient visits for a sore throat. During the visit, the doctor also removes a wart. The E/M

(sore throat evaluation) is separately identifiable from the procedure (wart removal).

Modifier 24

Unrelated E/M service by the same physician during a postoperative period.

Example: A patient is recovering from cataract surgery (in global period) and comes in for evaluation

of chest pain. The chest pain is unrelated to the surgery, so modifier 24 is applied to the E/M code.

Modifier 57

Decision for surgery.

Example: A patient presents with acute appendicitis. The provider performs a full evaluation and

schedules emergency surgery. Modifier 57 is applied to the E/M visit that led to the decision for

surgery.

Modifier 32

Mandated services.

Example: A government agency requires a mental health evaluation for a custody case. Modifier 32

is used to show the service was not patient-initiated but required by a third party.

Modifier 59

Distinct procedural service.

Example: Although not typically used on E/M codes, if two services are billed together and usually

bundled, modifier 59 may be used on the procedure code to indicate they are separate. Example:

An E/M visit and a physical therapy session on the same day, billed distinctly.
Modifier 52

Reduced services.

Example: A patient refuses part of a planned exam due to discomfort. The provider performs only

part of the standard E/M service. Modifier 52 shows the service was reduced.

Modifier 76

Repeat procedure by the same provider.

Example: A patient needs a repeat blood pressure check by the same physician later in the day due

to abnormal readings in the morning. Modifier 76 is added to the repeated service.

Modifier 77

Repeat procedure by a different provider.

Example: A patient is seen by Dr. A for an initial E/M. Later the same day, Dr. B (a colleague)

evaluates the patient again due to a new symptom. Modifier 77 is used on the second service.

You might also like