Tip: Get to know your minor procedures- global days Just because auditors are targeting modifier 25 doesn't mean you should cut out your use of this tool. CMS recently clarified how you should be using modifier 25. See if these common ob-gyn scenarios do or do not merit its use.
Recent reports of the Office of Inspector General (OIG) targeting claims containing modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) have made ob-gyn practices concerned.
Bottom line: -Every coder should always be concerned and reverent when using modifier 25,- says John F. Bishop, PA-C, CPC, president of Bishop & Associates Inc. in Tampa, Fla. -The OIG has really cracked down on this modifier and collected huge sums of money for inappropriate coding.-
Best bet: You should only use modifier 25 when your ob-gyn provides a significant and separately identifiable E/M service on the same day as a procedure with a global period.
You can read the CMS clarification (implementation date Aug. 20) at
www.cms.hhs.gov/transmittals/downloads/R954CP.pdf.
Scenario 1: Study This Same-Day Biopsy Example An ob-gyn sees a patient for an E/M service and identifies polyps in the cervical os. He decides to remove the polyps the same day instead of asking the patient to return.
Because the recent CMS clarification states that you should only append modifier 25 to an E/M code when a procedure has a global period, you should not use modifier 25 in this situation. The code for the biopsy (57500, Biopsy, single or multiple, or local excision of lesion, with or without fulguration [separate procedure]) has a global period of 000.
Where to find global periods: -I check for global periods two ways: the Coding Companion and the National Correct Coding Guide,- says Gloria Kirkham, CPC, coding specialist at Womens Health Partnership PC in Carmel, Ind.
-The best resource I have found is the RBRVS,- says Melissa Gifford, administrator at Etowah Valley OB/GYN PC in Cartersville, Ga.
Because the E/M service is significant and separately identifiable, you can still report both the E/M code and 57500. You simply do not need modifier 25 appended to the E/M code (such as 99213, Office or other outpatient visit for the evaluation of management of an established patient -).
End result: 57500, E/M service (such as 99213). Scenario 2: Check FB Removal's Global Days A patient with an impacted vaginal foreign body presents to the emergency department. Your ob-gyn [...]
