July 14, 2021

On using modifiers 59 & 25 ...

Do you bill multiple services on the same date?

Does modifier 25 & 59 confuse you?

Are you getting paid for these services?

You probably are using these modifiers the maximum and getting the denials as well.

59 for a distinct procedural service while 25 for a significant & separately identifiable E&M service could be confusing! The similarity between these codes makes it difficult and unknowingly gets miscoded.

The payers reject these services either due to incorrect coding, incomplete documentation, or lack of medical necessity.

Clear and complete medical records that support both services a must. A simple key is to remember to use modifier 25 on the E&M services and modifier 59 for non-E&M services only.

ACC provides an excellent document on when not to use and when to use modifier 25 whereas NCBI.NLM.NIH provides an article on the appropriate use of modifier 59.

Reference Links:




By clicking “Accept All Cookies”, you agree to the storing of cookies on your device to enhance site navigation, analyze site usage, and assist in our marketing efforts. View our Privacy Policy for more information.