Medical Auditing Practice Exam

In which scenario would modifier 25 be appropriately used?

1. A preventive exam is conducted with a minor procedure

2. A scheduled surgery is performed on the wrong body part

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

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

The correct answer is: 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.