Which modifier do you use if you do a new patient or re-exam and also adjust?

• A. 59
• B. 25
• C. 52
• D. 26

Answer: (B)

When you perform a new patient evaluation or re-exam on the same day you also provide a chiropractic adjustment, you’re delivering two distinct services. The evaluation is an E/M service, and you bill it separately from the adjustment by appending modifier 25 to the E/M code. This tells payers that the evaluation is significant and separately identifiable from the adjustment, so both can be reimbursed on the same day. Other modifiers aren’t appropriate here: 59 is used for distinct procedures when bundles would otherwise occur, but for an E/M plus an adjustment, 25 is the correct way to indicate a separately billable evaluation. Modifier 26 covers the professional component of a service, which isn’t the situation, and 52 denotes a reduced service, which doesn’t apply. Ensure documentation clearly supports that the E/M was a separate, substantive visit from the adjustment.