Orthopedic Coding Alert

If you're often mixing up your E/M modifiers, then clip this article and post it near your desk. You'll be sure to apply the appropriate modifier every time.

When you report modifier 24 (Unrelated evaluation and management service by the same physician during a postoperative period), the E/M service must meet these criteria:

• The E/M service occurs during the postoperative period of another procedure.

• The current E/M service is unrelated to the previous procedure.

• The same physician (or tax ID or same group and specialty) who performed the previous procedure provides the E/M.

Red flag: This is true even if the two physicians have different specialties or sub-specialties.

Appending modifier 25 (Significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service) means the E/M service must meet these requirements:

• The E/M is significant and separately identifiable from any "inherent" E/M component included with other services/procedures you report on the same day. The office visit is not merely preoperative in nature or an integral part of the minor procedure.

• The E/M may be related or unrelated to other procedures/services you report on the same day.

• The service/procedure the surgeon provides on the same day as the E/M service should have a zero-day, 10-day or "XXX" global period.

• The same physician bills the E/M and other procedures/services on the same day. For instance, the most common use of modifier 25 is an office visit (99201-99215) in conjunction with an injection (20526-20612).

To properly append modifier 57 (Decision for surgery), remember these points:

• The E/M service must occur the day of or the day before a major surgical procedure (a procedure with a 90-day global period).

• The E/M service must prompt the surgical procedure that follows.

• The E/M service must be related to the procedure that follows.

• The same physician (or tax ID) provides the E/M service and the surgical procedure.