Gastroenterology Coding Alert

Question: I-m trying to wrap my head around the new CMS notice about using modifier 25 only when the gastroenterologist performs an E/M service and a procedure on the same day. 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 gastroenterologist performs an E/M service and a service or GI diagnostic test with no global period on the same day. 
 
Bonus: As far as diagnoses go, you do not need a separate diagnosis for each procedure code. You can read CMS- full clarification here: www.cms.hhhs.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 service -- that's why there is a difference between zero global and no global.

Example: Your gastroenterologist performs an E/M service on the same day as 43246 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with directed placement of percutaneous gastrostomy tube). Because this procedure has a 000 global period, you should still apply modifier 25 to your E/M code, assuming that the E/M visit is a significant and separately identifiable service rather than a routine pre-operative workup associated with the percutaneous gastronomy (PEG) tube.