Neurosurgery Coding Alert

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

If your surgeon provides a billable E/M service on the same date as, or during the global period of, another procedure or service, you should append a modifier to the E/M code. If the E/M occurs during a global period, chances are you-ll reach for modifier 24.

To be sure of your choice--and to differentiate between modifiers 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) and 57 (Decision for surgery)--ask yourself these 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 problem that requires cognitive effort beyond what was paid in the global package of the previous surgery, and therefore should allow payment, 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. All payers include routine postoperative care during the global period in the global surgical package.

Example: A patient undergoes posterior laminectomy (63045, Laminectomy, facetectomy and foraminotomy [unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root(s) (e.g., spinal or lateral recess stenosis)], single vertebral segment; cervical). Two months later, the patient falls, leading to a new injury.

The surgeon performs an evaluation for this new, distinct problem. In this case, you should append modifier 24 to the correct E/M code (for example, 99213, Office or other outpatient visit for the evaluation and management of an established patient ...).

Learn more: For additional information on modifier 24, see -Call on 24 for Complication Evaluations--Maybe- later in this issue. 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 global period associated with the procedure, you should append either modifier 25 or modifier 57 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 with zero-day, 10-day or -XXX- global periods, you should append modifier 25 to the E/M code, says Linda Parks, MA, CPC, CCP, coding specialist for GI Diagnostics [...]