Understanding the "25" Modifier

Event Information
Product Format
Prerecorded Event
Conference Date
Thu, Mar 22, 2012
60 Minutes
Product Description

The “25” modifier has changed drastically in the last couple of years!! Let us review it carefully! 

Join expert speaker, Duane Abbey, as he simplifies the usage of “25” modifier, and how to:

  • Carefully review the definition of the “-25” modifier in the context of E/M coding.
  • Understand how this modifier has changed over the years.
  • Appreciate the physician use of the “-25” modifier.
  • Understand the use of the “-25” modifier for APCs.
  • Review the OIG findings for physician use of the “-25” modifier.
  • Review CMS guidance relative to the “25” modifier.
  • Appreciate the compliance issues surrounding hospital use of the “-25” modifier.
  • Review the findings of DOJ studies on hospital use of the “-25” modifier.
  • Discuss the difference between ‘unrelated’ and ‘separate’ services relative to the “-25” modifier.
  • Appreciate possible RAC activities with the “-25” modifier.

I. Overview of E/M Coding.

  • Types of E/M Levels. 
  • Physician Utilization. 
  • Hospital Utilization. 
  • Global Surgical Package Concept for Physicians. 
  • Surgical Package Concept for Hospitals

II. The “-25” Modifier.

  • Definition and Description in CPT. 
  • Physician Interpretation. 
  • Hospital Interpretation. 
  • Changes in the Definition Over the Years

III. Key Definitional Issues

  • Unrelated Services – Separate Diagnoses. 
  • Separate, Significantly Identifiable Services. 
  • Documentation Issues

IV. Compliance Issues.

  • Physician Utilization of the “-25” Modifier. 
  • OIG Report. 
  • Hospital Utilization of the “-25” Modifier. 
  • DOJ Studies .
  • Audit Guidelines. 
  • CMS Guidance. 
  • Possible RAC Involvement. 
  • OIG Study Findings

V. Case Studies

VI. Sources for Further Information 

Who should attend? Coding Personnel, Billing and Claims Transaction Personnel, Chargemaster Coordinators, Financial Analysts, Compliance Personnel, Physicians and Other Interested Personnel


Order Below or Call 866-458-2965 Today

You can also order through:




About Our Speaker

Duane Abbey Hospital Coding & Compliance Expert

 Duane C. Abbey, Ph.D. is a management consultant and president of Abbey & Abbey, Consultants, Inc., which specializes in healthcare consulting and related areas. Duane earned his graduate degrees at the University of Notre Dame and Iowa State University and has more than 20 years of experience as a consultant. He performs various types of financial analysis involving business structuring, organizational development, enrolment and other financially related concerns of organizations....   More Info
More Events By The Speaker

Why AudioEducator?
  • Save money on travel.
  • Meet your specific training needs.
  • Keep learning after the event.
  • Save time training your whole staff.
Join Our Mailing List
Our Accreditation Partners
Facebook Twitter Linkedin Youtube RSS Feeds Google Plus
Audio Educator


Dear Valued Customers


We regret to announce that ProEdTech LLC and all its affiliate brands will cease operations on April 1, 2019.


We are no longer able to fulfill online orders. We will fullfill all DVD and book orders already placed.


Customers of canceled webinars and subscription products may request a refund at (800) 223-8720 or service@proedtech.com. You must do so by April 1, 2019.


Thank you for your business and loyalty over the years. We sincerely apologize for any inconvenience caused.


Best regards,

The ProEdTech Team