A patient comes to the office for an annual physical and at the end of the examination the patient complains of low back pain that has been bothering him for a few weeks. Which modifier should be used with the E/M code for the low back pain to explain the need for two E/M codes at the same visit?
A) 22
B) 23
C) 24
D) 25
E) 26

Question

Quizplus · Accepted Answer

Modifier 25 is used to indicate that on the day of a procedure or service identified by a CPT code, the patient's condition required a significant, separately identifiable E/M service above and beyond the other service provided or beyond the usual preoperative and postoperative care associated with the procedure that was performed. In this scenario, the patient's complaint of low back pain, which was not part of the planned annual physical, necessitates an additional E/M service, making modifier 25 the correct choice.

A Patient Comes to the Office for an Annual Physical