Neurology & Pain Management Coding Alert

Question: Notes indicate that after a level-four outpatient evaluation and management (E/M) service for an established patient, the provider implanted a percutaneous epidural neurostimulator electrode array. Should I append modifier 25 to the E/M code to separate it from the surgery?

Iowa Subscriber

Answer: In this case, yes. You’ll report 63650 (Percutaneous implantation of neurostimulator electrode array, epidural) for the array implant, and 99214 (Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using time for code selection, 30-39 minutes of total time is spent on the date of the encounter.) with 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) appended to the E/M to show that the E/M and the surgery were separate, significantly identifiable services.

Why 25? The reason you use modifier 25 for the E/M on your claim is that 63650 has a global surgical period of 10 days, making it a minor surgery. Surgeries with a 0-day globals are also considered minor, and any E/M accompanying a surgery with a 0- or 10-day global (or procedures not covered by global rules) should have modifier 25 appended.

There is another option for other circumstances, though.

If you are coding for a separate E/M with a major surgery — one with a 90-day global surgical period — you’ll use modifier 57 (Decision for surgery) on the E/M instead of 25 to separate the E/M from the surgery.

Best bet: Check the Medicare Physician Fee Schedule (MPFS) for global period information on each CPT^® code.