Gastroenterology Coding Alert

To ease payment for your claims for modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service), check the claims against the following:

Have complete and separate documentation for the E/M service, apart from documentation for any other services/procedures the gastroenterologist provides that day. Treat E/M codes as part of a different encounter. Documentation should independently support every code you claim. 

Whenever possible, attach a different diagnosis for the E/M service. Although this is not required, a unique diagnosis will help establish the separately identifiable nature of the E/M service. 

Use the boxes on the CMS-1500 (or other) claim form to explain the significant and separately identifiable nature of the E/M service.

Be certain that you are not billing for care included in the global period of a previous surgery. You may not separately report E/M services the gastroenterologist provides during the routine preprocedure sedation assessment of a related procedure.

Don't miss: If the physician provides an E/M service during the global period of an unrelated procedure, however, you may report the appropriate E/M service code appended with modifier 24 (Unrelated evaluation and management service by the same physician during a postoperative period).