Coding & Reimbursement: Use and Abuse of Modifier -25

Review the guidance and conduct an internal audit to confirm that your providers and staff are applying this modifier appropriately.

By: Mary Pat Johnson, COMT, CPC, COE, CPMA

Ophthalmology Management January 9, 2026

5 Key Takeaways

1

Modifier -25 is used to identify a billable office visit performed on the same day as a minor surgery.
2

Ophthalmologists report modifier -25 on about 16% of office visits, which the Office of the Inspector General considers potentially excessive.
3

Modifier -25 should only be used when the office visit is significant, distinct, and unrelated to the decision for the minor surgery.
4

Documentation must thoroughly describe the encounter, including all conditions addressed and treatment options considered.
5

Modifier -25 is appended to E/M or eye codes, not to minor procedure codes, and should not be used for every minor procedure.

Mary Pat Johnson

Bio: Mary Pat Johnson, COMT, CPC, COE, CPMA, writes on ophthalmic coding, documentation, and compliance for Ophthalmic Professional. Her work addresses practical documentation issues in ophthalmic practices, including scribe roles, chart accuracy, and compliance actions informed by chart audits.

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Ophthalmology Management

Coding & Reimbursement: Use and Abuse of Modifier -25

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