Orthopedic Coding: Real-world Tips To Get Your Modifier 25 Right

By Author: Julia Rose
Total Articles: 89
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For an orthopedic coder, knowing when to report modifiers and choosing the best one for each situation can be quite challenging. So if modifier 25 is giving you a tough time, here are some real-world tips that will help you code with confidence every time.


a) Check whether the service is significant. As explained by CPT's Appendix A, a significant and separately identifiable service is defined or substantiated by documentation and satisfies the relevant criteria for the respective E/M service to be reported.


b) Check for additional work. In case the diagnosis remains the same, you have a third question to ask: Did your orthopedist perform extra work that went above and beyond the typical pre- or postoperative work associated with the procedure code? Another positive answer points you to modifier 25.


c) Look for pre-planning: Modifier 25 is meant for those oh, by the way type situations and not procedures that are tied to previous services.


But remember that you can consider reporting modifier 25 only while coding an E/M service. If the procedures you ...
... are reporting do not fall under E/M services, you'll need to check if the encounter qualifies for modifier 59.


If you're not well-informed, you run the risk of getting it wrong with your modifier coding. One way to stay up to date is by attending orthopedic coding seminars and conferences. But in case you've missed out on orthopedic coding seminars 2010, worry not; there are CDs and MP3s to run you through them and help you stay informed. When you tune in to them, you'll arm yourself with all orthopedic coding know how and pretty soon you'll realize that the ‘trip up' you had while reporting modifiers is done and over with.


Keep on updating your knowledge about Orthopedic coding by attending Orthopedic coding conference with premier coding experts, CDs, tapes and transcripts of coding training information by specialty.