You’re trimming a diabetic ulcer and managing new-onset gout in the same visit. Can you bill both the procedure and an E/M? Yes—if you use Modifier 25 correctly.
In 2025, Modifier 25 (significant, separately identifiable E/M on the same day as a procedure) is podiatry’s golden ticket. But payers like Medicare and UHC audit it hard. One wrong note = bundled payment or denial.
Here’s exactly how mid-market podiatry groups bill E/M + procedure cleanly—no red flags, no takebacks.
When Modifier 25 Works (and When It Doesn’t)
Rule: The E/M must be above and beyond the usual pre/post work of the procedure.
Podiatry-Specific Examples
Note Template
CC1: Routine paring calluses, bilateral
CC2: New L heel pain x5 days, worse with 1st step
HPI (E/M): 68 y/o DM2, new L heel pain, sharp, 7/10, morning stiffness. No trauma.
Exam (E/M): L heel tender plantar fascia insertion, +windlass test.
MDM (E/M): Suspect plantar fasciitis. Start stretch, NSAID, RTC 2wks.
Procedure: Paronychia #2 R toe, avulsion under block (11056).
Post-op: Dressing, tetanus update.
Time: 28 min total, 15 min on heel eval/counseling.
Result: 99213-25 + 11056 → paid both.
Red Flags That Trigger Denials
Tips for Podiatry Billing Teams
- Train your AI scribe: Auto-split “Procedure” vs “E/M” sections.
- Run a weekly 25 audit: Pull last 10 claims with 11730/17110. Check separate HPI.
- Use a pre-chart checklist: “New problem today? → Document separately.”
- EHR hack: Add a Modifier 25 smartphrase that forces dual documentation.
Modifier 25 isn’t a loophole—it’s a rule. Document two distinct services, and you’ll bill E/M + procedure with confidence.
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