Question: Florida Subscriber Answer: You include the E/M services the physician provides on the same calendar day in the heart cath unless the services are for a significant, separately identifiable reason, such as high blood pressure. In this case, you would append modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to the appropriate E/M code. Remind your physician to summarize in his notes any care the patient will receive after the heart cath. Doing so will help justify an E/M code following the cath procedure. In some cases, when a patient has a heart cath, she could stay past midnight. Because heart caths have a zero-day global period, any E/M service, such as a discharge, the physician provides on the next calendar day should be separately payable. If the physician assigns observation status to the heart-cath patient, you could bill 99217 (Observation care discharge day management) if the physician discharges the patient the next calendar day. If the heart-cath patient has inpatient status and the physician discharges him on the next calendar day, use 99238 (Hospital discharge day management; 30 minutes or less) or 99239 (... more than 30 minutes). If the hospital considers cardiac catheterization an outpatient (but not an observation) procedure, use the appropriate code for an established patient visit (99211-99215) because CPT does not include a separate code for outpatient discharges.