EM Coding Alert

Hint: Modifier 24 is defined by the post-op period.

But, watch out. Make sure you’re keeping an eye on 90-day global periods connected to a major procedure — and don’t use modifier 25 in such situations. Check out this primer on other modifiers that you can use for more accurate coding.

Remember 90 Days for Post-Op Period

Sometimes, a physician examines a patient within the 90-day global period of a major procedure, but for a different problem.

Even if your providers don’t frequently perform surgeries with 90-day globals, it’s important to understand how to report these when they do arise.

For instance, suppose the physician performs a procedure that carries a 90-day global period. A month later, the same physician sees the patient for a problem completely unrelated to the previous surgery. That might be when you call on modifier 24 (Unrelated evaluation and management service by the same physician or other qualified health care professional during a postoperative period).

When you report modifier 24, the E/M service must meet these criteria:

• The E/M service occurs during the postoperative period of another procedure.
• The current E/M service is unrelated to the previous procedure.
• The same physician (or tax ID or same group and specialty) who performed the previous procedure provides the E/M.

Don’t forget: Medicare and many other payers have very specific guidelines for what qualifies as “related” to the original procedure and what doesn’t. For instance, Medicare will always treat postoperative infections as related to (and therefore, included in the global surgical package of) the initial surgery — unless your provider must return the patient to the operating room (OR) to deal with an infection. Modifier 24 should be used only when the subsequent E/M service is unrelated to the original procedure.

Use Modifier 57 for Same-Day E/Ms, Surgeries

Occasionally, a physician wants to rush a patient into the OR as a result of an exam. When your physician decides to perform a minor procedure as a result of an E/M service, you append modifier 25. When it’s a major procedure the doctor performs the same or next day, you’ll call on modifier 57 (Decision for surgery).

You should append modifier 57 to an E/M service that occurs on the same day, or on the day before, a major surgical procedure, and which results in the physician’s decision to perform the surgery. Guidelines from the Centers for Medicare & Medicaid Services (CMS) identify a major surgical procedure as any procedure with a 90-day global period. Note that the global period for a major surgical procedure begins one day prior to the procedure itself.