ENT Modifier 25

Question:

Does the following scenario meet the modifier 25, “significant, separate service” rules? 

The patient presents with watery eyes, sinus, nasal congestion, and drainage.   The physician evaluates the patient and does a nasal endoscopy to evaluate the upper airway further.   The physician diagnoses the patient as having acute sinusitis and writes a prescription for an antibiotic.  Instructions are given on taking the medications and following up if the patient has seen no improvement after 72 hours.   

May we report an E&M-25 and the nasal endoscopy?

Answer:

Yes, the scenario you present meets the definition of modifier 25. The E&M was not performed for the purpose of the nasal endoscopy, and the physician had additional decision-making related to the management of the sinusitis.

*This response is based on the best information available as of 11/14/24.