EM Coding Alert

Question: My cardiologist saw an inpatient for acute claudication/ischemia of the foot and recommended peripheral vascular angiography with possible intervention. The same day, the cardiologist performed angiography and mechanical thrombectomy of the patient's popliteal artery. Can I use modifier 25 to report the E/M code and the procedure codes?

Colorado Subscriber

Answer: Yes. In this case, you can append modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service) to your E/M code, which, for example, could be the 99233 (Subsequent hospital care, per day, for the evaluation and management of a patient ...) E/M visit code.

You would also report the following for the procedures your physician performed:

• A diagnostic angiography code, such as 75716 (Angiography, extremity, bilateral, radiological supervision and interpretation) with modifier 26 (Professional component) appended to indicate that you're coding only the angiography's professional component
• Code 37184 (Primary percutaneous transluminal mechanical thrombectomy, noncoronary, non-intracranial, arterial or arterial bypass graft, including fluoroscopic guidance and intraprocedural pharmacological thrombolytic injection[s]; initial vessel) for the popliteal artery thrombectomy
• A catheter placement code, such as 36247 (Selective catheter placement, arterial system; initial third order or more selective abdominal, pelvic, or lower extremity artery branch, within a vascular family).

Take note: Modifier 25 is one of the most misunderstood modifiers, so if you ever have doubts about whether you are properly using it in the future, heed the following information:

• You can only append modifier 25 to E/M service codes 99201 (Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 components ...) through 99499 (Unlisted evaluation and management service).
• You may use modifier 25 only when your provider's documentation proves that he performed a medically necessary and "significant, separately identifiable" E/M service in addition to the original procedure. Your physician must include a separate History, Examination, and Medical-decision making (HEM) for the E/M service in his documentation.
• The E/M service must occur on the same calendar day as the original procedure, for the same patient.
• You do not necessarily need two different diagnosis codes to append modifier 25. While different diagnoses help show the separate nature of the E/M service, they are not required for using modifier 25. 
• The procedure following the E/M would be a minor procedure, meaning that it has a zero or 10-day global period. For 90-day procedures, you would instead use modifier 57 (Decision for surgery) on the E/M service.