Here’s why you need to know global periods when considering 24, 25. A coding myth can kill a claim before it’s even born. And nowhere do the myths fly faster than around modifiers for evaluation and management (E/M) codes. Coding is difficult enough, and modifiers are sometimes an afterthought when coding claims. Knowing when to appropriately append modifiers, however, saves valuable dollars and work hours for your practice. Here’s a couple of myths around a pair of common E/M modifiers, debunked by our experts. Myth: You Can Append Modifier 24 if E/M Service Related to Original Surgery Truth: You should only attach modifier 24 (Unrelated evaluation and management service by the same physician or other qualified health care professional during a postoperative period) to an appropriate E/M code when the physician renders the E/M service during a 10 or 90-day postoperative global period for reasons unrelated to the patient’s original surgery. Also, modifier 24 only applies to services your physician performs after the surgical procedure within the global period of that procedure. Don’t forget: The medical record must support that the E/M visit was unrelated to the postoperative care, and the diagnosis should clearly indicate the reason for the unrelated postoperative encounter. Coding scenario: The physician completed a L5 laminectomy on a patient. Two months later, the patient presented to the ED with headache, neck stiffness, and fever. The physician that performed the laminectomy was brought in and completed a lumbar puncture while the patient was still in the ED. Assuming the problem is unrelated to the patient’s initial surgery, you will report the ER visit and lumbar puncture, appending the correct modifiers. The correct codes are as follows: Myth: Modifier 25 Applies to Major Procedures Truth: You should only append modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service) to indicate a distinct E/M with a minor procedure (zero or 10-day global period) performed on the same day. » » When you append modifier 25, follow the following rules: Coding scenario: An established patient has a concussion, and the physician performs an E/M service to evaluate the concussion that includes a problem-focused history, a problem-focused exam, and straightforward medical decision-making. At the same session, the physician also administers a computerized neuropsychological test to determine the impact of the concussion. For the neuropsychological test, you would report 96120 (Neuropsychological testing (eg, Wisconsin Card Sorting Test), administered by a computer, with qualified health care professional interpretation and report). Since the physician performed the neuropsychiatric testing and the E/M service in the same session, you should append modifier 25 to 99212 (Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: a problem focused history; a problem focused examination; straightforward medical decision making…). Coding tip: You must make sure the documentation demonstrates the separate nature of the two services. “In order to report both the E/M service and the procedure, the decision to perform the testing must be based on the findings obtained through the E/M service itself,” says Gregory Przybylski, MD, past chairman of neurosurgery and neurology at the New Jersey Neuroscience Institute, JFK Medical Center in Edison, New Jersey. “The E/M service would not be reportable if the purpose of the visit was to perform the test alone.”