Medical Auditing Practice Exam 2025 – The Comprehensive All-In-One Guide to Exam Success!

Question: 1 / 400

In which scenario would modifier 25 be appropriately used?

A preventive exam is conducted with a minor procedure

A scheduled surgery is performed on the wrong body part

A patient consults a physician for a new issue during a regular visit

A patient presents with new symptoms during a scheduled appointment for a lesion removal

Modifier 25 is utilized in scenarios where a significant, separately identifiable evaluation and management (E/M) service is provided on the same day as another procedure or service.

In the case where a patient presents with new symptoms during a scheduled appointment for a lesion removal, the provider is addressing two distinct issues: the scheduled procedure (lesion removal) and the new symptoms that require evaluation and management. Since the physician is performing a separate and significant E/M service in addition to the procedure, modifier 25 should be applied to indicate that the E/M service is warranted and different from the procedural service being billed.

This modifier helps ensure proper reimbursement for both the procedure and the additional E/M service, recognizing that the physician's work goes beyond performing the procedure alone.

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