General Surgery Coding Alert

Question: The surgeon sees a patient in consult-ation for cellulitis of the arm. The next day, the surgeon performs an incision and drainage (10061) for an abscess of the right forearm--which has a 10-day global period--for the same patient.

Should I use modifier 25 in this case?


Illinois Subscriber


Answer: You should only append modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to E/M service codes, and only if a significant, separately identifiable E/M service occurs on the same day as the procedure or other service.

Because the consult (99241-99245 outpatient, or 99251-99255 inpatient) and incision and drainage occur on different days, you should not append modifier 25. Had the surgeon provided the consult as a separately identifiable service and then performed the I&D (in your case, 10061, Incision and drainage of abscess [e.g., carbuncle, suppurative hidradenitis, cutaneous or subcutaneous abscess, cyst, furuncle or paronychia]; complicated or multiple), you would then be correct to append modifier 25 to the appropriate service level consult code.

If the surgeon provides an E/M service the day after (or otherwise during the global period of) a procedure, your coding will vary depending on whether the E/M service is related to the previous procedure.

When the post-op E/M service is related to the previous procedure, the service is bundled in the procedure's global period. Therefore, you cannot report the E/M service separately, regardless of whether you use modifiers.

But if the post-op E/M service is unrelated to the previous procedure, you may report the service separately by choosing the appropriate E/M service code and appending modifier 24 (Unrelated evaluation and management service by the same physician during a postoperative period).