Modifier Advisor · Pro
Per-criterion modifier evaluation.
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“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_06504f1fModifier 25
85% confidence — append to CPT 99213.
Distinct chief complaint or condition
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
Physical exam findings (tenderness, windlass test) and conservative-treatment discussion go above routine pre-injection work.
E/M documentation satisfies the level reported (99213)
Documentation supports an E/M but doesn't fully confirm all elements for moderate MDM at 99213 level.
Separately reportable per NCCI
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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