READER QUESTIONS:
Prove Separate Service Before Billing E/M in Global
Published on Thu Apr 09, 2009
Question: Our payer is denying a claim involving an E/M and an FNA for an improper modifier. Is modifier 59 appropriate? California Subscriber Answer: Most payers, including Medicare carriers, require modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) on minor procedures. You should consider procedures with a zero- or 10-day global period as minor procedures. Caution: Don't just put a modifier on your E/M visit code to get paid. Make sure your E/M is a significant, separately identifiable service from the minor E/M service that payers associate with the procedure. CPT considers minor procedures to have a very small E/M already included with the procedure. Therefore, insurers won't pay an E/M unless it is a significant, separately identifiable service. And Medicare will not pay an E/M separately on the same date of service as a [...]