General Surgery Coding Alert

Assign 57, not 25, for E/M prior to a major surgical procedure

If your surgeon provides an E/M service on the same date as, or during the global period of, another procedure or service, you-re going to have to append a modifier to the  E/M code. To be sure of your choice--and to differentiate between modifiers 25 and 57--ask yourself two questions. Question 1: Does the E/M Follow Another Service? When an E/M service occurs during a postoperative global period, but for reasons unrelated to the original procedure, you should append modifier 24 (Unrelated evaluation and management service by the same physician during a postoperative period) to the appropriate E/M code. By appending modifier 24, you make the payer aware that the surgeon is seeing the patient for a new problem, and therefore the E/M service is not included in the global surgical package of the previous procedure, says Marvel J. Hammer, RN, CPC, CHCO, owner of MJH Consulting, a healthcare reimbursement consulting firm in Denver.

Remember: You cannot bill separately for related services during the global period. Routine postoperative care during the global period is included in the global surgical package.

Example: A long-term patient has two toes amputated. During postoperative rounds, the surgeon notes an ulcer on the calf region of the same leg, which requires dressing, antibiotics and other attention.

The surgeon performs an evaluation for this new, distinct problem (that is, the ulcer is unrelated to the toe amputation). In this case, you should append modifier 24 to the correct E/M code (for example, 99232, Subsequent hospital care, per day, for the evaluation and management of a patient ...).

Learn more: Look to next month's General Surgery Coding Alert for additional information on modifier 24. Modifier 24: Conditions for Use 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) who performed the previous procedure provides the E/M. Question 2: -Major- or -Minor- Procedure? When the surgeon decides to perform another procedure during an E/M service and provides the procedure on the same day (or, for major procedures, the same day or the next day), you can bill the E/M service separately. Depending on the length of the procedure's global period, you should append either modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) or modifier 57 (Decision for surgery) to the appropriate E/M code.

Minor procedures mean 25: If the surgeon provides a significant, separately identifiable E/M service on the same date as a minor procedure, including those [...]