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Cardiology Coding Alert

Reader Question:

Modifier -25 and Global Periods

Published on Fri Mar 01, 2002

Question: Consult service 99254 is performed on the same day as placement of a central venous catheter (CVC), which we report using 36489. Should we append modifier -57 to 99254?
      
Texas Subscriber
 
Answer: Code 36489 (Placement of central venous catheter [subclavian, jugular, or other vein] [e.g., for central venous pressure, hyperalimentation, hemodialysis, or chemotherapy]; percutaneous, over age 2) has 0 global days. Therefore, modifier -25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service), rather than modifier -57 (Decision for surgery), should be appended to the E/M service (99254) that determined the need for the CVC placement. Medicare guidelines specify that modifier -57 is limited to E/M services provided the day before or on the same day as procedures with 90-day global periods. For surgery with 0- or 10-day global periods, the appropriate E/M code should be appended with modifier -25.
 
Note: Some carriers may not recognize modifier -57 claims and require modifier -25 for all surgeries. Others may determine that any code in the surgical section describes a surgery and, therefore, insist that modifier -57 be appended to the E/M performed on the same day as any surgical procedure, regardless of the number of global days.
 

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