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Per-criterion modifier evaluation.

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Procedure99213+20550
·
DxM72.2

“Established patient, chronic plantar heel pain, plantar fasciitis. Tender at medial calcaneal tubercle. Discussed home stretching, NSAID review, night splint. Same encounter, corticosteroid injection at plantar fascia origin.”

Recommended

trace_id lf_t_dev_06504f1f

Modifier 25

85% confidence — append to CPT 99213.

Distinct chief complaint or condition

PASS90%

E/M addressed overall management of plantar fasciitis (home stretching, NSAID review, night splint) distinct from the injection.

Above and beyond the procedure's usual pre/post-op care

PASS90%

Physical exam findings (tenderness, windlass test) and conservative-treatment discussion go above routine pre-injection work.

E/M documentation satisfies the level reported (99213)

WEAK60%

Documentation supports an E/M but doesn't fully confirm all elements for moderate MDM at 99213 level.

Separately reportable per NCCI

PASS90%

Per NCCI guidelines an E/M can be separately reported with minor procedure 20550 when significant and separately identifiable.

NCCI WEAK · 99213 ↔ 20550 · override allowed with documented modifier.

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