Orthopedic Coding Alert

Minor vs. major makes all the difference Modifiers 25 and 57 are two E/M modifiers that often cause confusion for coders. To understand when to properly use these modifiers, you should first understand a few coding concepts. Start With a Few Definitions According to CPT, the surgical package always includes the following services in addition to the operation: - local infiltration, metacarpal/metatarsal/digital block or topical anesthesia - subsequent to the decision for surgery, one related E/M encounter on the date immediately prior to or on the date of the procedure (including history and physical) - immediate postoperative care, including dictating operative notes and talking with the family and other physicians - writing orders - evaluating the patient in the postanesthesia recovery area - typical postoperative follow-up care. A minor procedure is a procedure that bundles zero or 10 global days of postoperative care into its surgical package, according to Medicare. And a major procedure is a procedure that bundles 90 global days of postoperative care into its surgical package, according to Medicare. Use PFS to Determine Surgical Package CPT's definition of the surgical package is only part of the story. The Medicare Physician Fee Schedule (PFS) contains a lot of important information regarding payment for all CPT codes, including the Global Surgery Indicator. This indicator provides time frames that apply to each surgical procedure. Here's how the PFS breaks down the indicators: - 0 days (000) -- Endoscopic or minor procedure with related preoperative and postoperative relative values on the day of the procedure only included in the fee schedule payment amount; E/M services on the day of the procedure are generally not payable. - 10 days (010) -- Minor procedure with preoperative relative values on the day of the procedure and postoperative relative values during a 10-day postoperative period are included in the fee schedule amount; E/M services on the day of the procedure and during the 10-day postoperative period are generally not payable. - 90 days (090) -- Major surgery with a one-day preoperative period and 90-day postoperative period included in the fee schedule amount. - Maternity (MMM) -- Maternity codes; usual global period does not apply. - N/A (XXX) -- The global concept does not apply to the code. - Carrier (YYY) -- The carrier determines whether the global concept applies and establishes postoperative period, if appropriate, at time of pricing. - Other (ZZZ) -- The code is related to another service and is always included in the global period of the other service.     Think Modifier 25 for Minor Procedures You should append modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other [...]