Using Modifier 25 in Otolaryngology: Rewards and Ramifications 

Appending modifier 25 (Significant, Separately Identifiable Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional on the Same Day of the Procedure or Other Service) to an Evaluation and Management (E/M) code, when also billing a minor procedure on the same day, typically results in payment for both services – the reward.  But is it correct?

Payors, including the Office of the Inspector General (OIG), have been auditing the proper use of modifier 25 and recouping millions of dollars from otolaryngologists – the ramification.  A common misconception is that the E/M code and procedure code are always billed together.  That’s just not true.  There are times when it is not appropriate to also report the E/M code but bill only the procedure.

Learning Objectives

We will review:

  • CPT and Medicare guidelines for applying Modifier 25.
  • Real scenarios frequently encountered in otolaryngology practices.
  • When it is and is not appropriate to bill E/M and procedure codes.

You will gain a better understanding of how to correctly Modifier 25 when performed with common ENT minor procedures including:

  • Nasal endoscopy
  • Flexible laryngoscopy
  • Endoscopic sinus debridement
  • Excision of skin lesion
  • Cerumen removal


Deborah is a nationally sought after leader in the industry and is passionate about assisting physicians and hospitals in improving their coding, documentation, and business operations to maintain compliance and improve revenue. She will go above and beyond to help industry leaders, physicians and others achieve excellence. Her motto is “documentation excellence is the key to improving revenue.”

Earn 1.5 CEU Credits
*You will have access to the content for 30 days from the time you receive the access information.
Please email if you have questions.

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