Hi,
The following is from Blue Cross Blue Shield and it explains the 2 modifiers. They are similar but should be used for different things. For example, I use the 25 modifier for one of my doctors because he will do an office visit (E&M code) in addition to osteopathic manipulation on the same visit. The E&M is separate from the osteopathic manipulation so I attach the 25 modifier and he receives payment for both codes. I use the 59 modifier for PT codes when I bill 97110 along with 97530 or 97140. I attach the 59 modifier to the 97530 & 97140 and again all codes are allowed. Without the 59 modifier the 97530 & 97140 are bundled into the 97110. I hope this helps.
Michele
Modifier 25
Definition: Significant and Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure or Other Service.
Modifier 25 is used to describe separate, distinctly identifiable services from other services or procedures rendered during the same visit. Always attach the modifier to the evaluation and management code.
Some examples of separate and distinctly identifiable services are:
* Initial hospital visit, initial inpatient consultation or hospital discharge and an inpatient dialysis service. Modifier 25 would be appropriate on the E&M code.
* Unscheduled E&M service performed the same day as a preventive exam-when the service is in addition to the preventive care.
Do not use modifier 25:
* On surgical codes.
* On services that resulted in the decision to perform surgery.
Modifier 59
Definition: Distinct Procedural Service
Modifier 59 is used to clearly designate when distinct, independent and separate multiple procedures are provided. The procedure must not be a component of another procedure.
Examples of when to use modifier 59:
o Different procedures or surgeries
o Surgery on different sites or organ systems
o Separate incision/excision
o Separate lesions
o Treatment to separate injuries
Documentation may be required to support the use of modifier 59.
Do not use modifier 59 on all procedures on the claim. This will negate the purpose of the modifier.