Neurology & Pain Management Coding Alert

Appending modifier -25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) is a legitimate and effective method to obtain payment for a significant, separately identifiable E/M service provided on the same day as another service or procedure. To facilitate payment of your modifier -25 claims, check your claim against the following:

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

- Be sure the E/M service you report is significant (in other words, documentation should support at least a level-three patient encounter: 99203, 99213).

- 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 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. Although neurologists will not encounter this often, you may not separately report E/M services the physician provides during the global period of a related procedure. If the physician provides an E/M service during the global period of an unrelated procedure, attach modifier -24 (Unrelated evaluation and management service by the same physician during a postoperative period) to the E/M service code.