ED Coding and Reimbursement Alert

Question: As far as I understand, modifier -57 is appropriate when a physician makes a decision for a surgical procedure with a 90-day global period, such as 23650 (Closed treatment of shoulder dislocation, with manipulation; without anesthesia). When appending modifiers to evaluation and management codes, should I make this distinction between procedures of varying global periods, or should I append modifier -25 regardless of global days?
      
Arizona Subscriber Answer: Yes, the global days do matter when you're appending modifiers. According to Medicare rules, you should use modifier -57 (Decision for surgery) to represent the E/M service that contributed to the decision for surgery for a major procedure (defined as a global surgical package of 90 days). You should 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 E/M code when the physician performs a separately identifiable service in addition to a minor procedure (defined as a 0- or 10-day global surgical package).