Cardiology Coding Alert

'000' Global Days Still Mean Global Period Question: I'm trying to wrap my head around the new CMS notice about using modifier 25 only when the cardiologist performs an E/M service and a procedure on the same day. Does that include stress tests? Do we need a separate diagnosis?
Montana Subscriber
Answer: You should forgo using modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) whenever your cardiologist performs an E/M service and a procedure with no global period on the same day. Example: Because stress tests (such as 93015, Cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous electrocardiographic monitoring, and/or pharmacological stress; with physician supervision, with interpretation and report) have no global period, you can report both 93015 and the E/M code (such as 99214, Office or other outpatient visit for the evaluation and management of an established patient) without modifier 25. Your claim should look like this: • 93015 • 99214 Bonus: You do not need a separate diagnosis for each procedure code. You can read CMS' full clarification at www.cms.hhs.gov/MLNMattersArticles/downloads/MM5025.pdf. Warning: Procedures that have a 000 global period still have a global period. Minor procedures that have zero or 10 global days still have a prework component that includes a history and physical and is the equivalent of a minor E/M--that's why there is a difference between zero global and no global. Example: Your cardiologist performs an E/M service on the same day as a left heart catheterization (93510, Left heart catheterization, retrograde, from the brachial artery, axillary artery or femoral artery; percutaneous). Because this procedure has a 000 global period, you should still append modifier 25 to your E/M code, assuming that the E/M visit is a significant and separately identifiable service rather than routine preoperative workup associated with a scheduled heart catheterization.