Cardiology Coding Alert

Question: The cardiologist interpreted an echo for a hospital patient in the morning (93306-26), and I billed that. Later in the day the cardiologist performs a consult for the patient (99254). Do I need to append modifier 25 to 99254?

South Carolina Subscriber

Answer: Although payer policies may vary, you should not need to append modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service) to 99254 (Inpatient consultation for a new or established patient ...) on the same date that you report 93306-26 (Echocardiography, transthoracic, real-time with image documentation [2D], includes M-mode recording, when performed, complete, with spectral Doppler echocardiography, and with color flow Doppler echocardiography; Professional component).

Your use of consult code 99254 suggests the patient is not under Medicare (which does not accept consult codes). But it is still worth noting that the Medicare Physician Fee Schedule assigns 93306 XXX global days (meaning no global period). Many payers require use of modifier 25 on an E/M performed on the same date as a procedure with assigned global days but not with global XXX.

Also, Correct Coding Initiative edits do not bundle 93306 and 99254, so not including the modifier won't trigger a denial based on edits.

Remember: It is possible that a payer will require you to always append a modifier to an E/M to show that it is distinct from a same-day procedure, so track payer preference.