# E/M on same date as Procedure



## zaida120 (Jan 15, 2009)

Does anyone have trouble getting medicare to pay on an E/M code on the same date as procedure with modifiers 25 and 57?


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## Teresa Collins (Jan 16, 2009)

We do not have any problem with Medicare paying for E/M codes with modifier 25.  We rarely have a case where we have to bill with modifier 57.

You might want to double check the ICD-9 code that is being used for the procedure.  


Hope this helps!

Teresa Collins, CPC


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## zaidaaquino (Jan 16, 2009)

Hi, Zaida.  My name is Zaida, too!  Well, in regards to your question, once in a while we do get a denial.  But as long as our documentation supports our charges, we appeal the denial.  Do you have a specific example?

Zaida V. Aquino, CPC


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## loughreykylene (Jan 16, 2009)

We do not have any problems with medicare paying. 

Modifier -25 is “significant, separately identifiable evaluation and management (E&M) by the same physician on the same day of the procedure.” It is E&M that resulted in a decision to perform a minor surgery. (10 day or less global days.)

Modifier -57 is “decision for surgery. (It is) an E&M service that resulted in the initial decision to perform the surgery. This modifier is used to report an E&M service that resulted in a decision to perform a major surgical procedure on the day of or the day before the surgery.”
(90 day global period procedures)

Source: Medicare Part B newsletter # 01-020, dated Sept.1, 2001, page 15. (PDF )

Hope this helps.


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