Part B Insider (Multispecialty) Coding Alert

Published on Sat Aug 12, 2006 PDF

Make a spreadsheet of your common procedures and their global periods

Minor procedures may pose a major challenge to coders, if you ignore their global periods.

Many coders don't realize that even procedures with a -0- in their global field require a modifier if the physician performs a significant and separate evaluation & management service on the same day.

Important: When the physician performs an evaluation & management (E/M) service on the same day as a procedure with a zero-day or 10-day global period, you should use the 25 modifier, not the 57 modifier. The 57 modifier is only for E/Ms on the same day as a major procedure (one with a 90-day global period), says Jim Collins with the Cardiology Coalition.

Often, coders leave out the 25 modifier on an E/M because the charge ticket for the E/M comes in first, says Sandy Fuller, compliance officer with Cardiovascular Associates of East Texas in Tyler, TX. The procedure comes in later, and when the coder bills it, Medicare will deduct the payment already made for the same-day E/M.

You should keep your eyes open for these situations, so you can appeal the reduction and add the 25 modifier to your E/M visit retroactively, says Fuller. Educate your billing staff to make sure all significant and separate E/M visits have the 25 modifier.

Remember: Even some diagnostic procedures, such as left heart catheterization (93510), may have a global period, says April Leaver, patient accounts manager with Morristown Cardiology Associates in Morristown, NJ.

Watch out: If you bill routinely for E/Ms on the same day as minor procedures, you may trigger an audit from your carrier or the HHS Office of Inspector General, warns Stacie Buck, vice president with Southeast Radiology Management in Stuart, FL. Some physicians always want to bill separately for the standard history and physical exam which are part of the pre-service work for a minor procedure, say experts.

If you perform a second procedure on the same day as a minor procedure, then you should use the 76 or 77 modifier, depending on whether it was the same procedure, says Maggie Mac, a healthcare consultant in Clearwater, FL.

Mistake: Don't put the 25 modifier on the procedure instead of the E/M visit, warns Mac. The OIG recommended collecting huge overpayments from providers who made this mistake in its recent report on 25 modifiers.

Bottom line: Pay attention to the global period assignment for each procedure, says Carol Pohlig, a senior coding and education specialist at the University of Pennsylvania-s department of medicine in Philadelphia. Some private payors may have their own designated global periods. -Make a spreadsheet with common surgical services and their associated post-op periods by payor,- Pohlig advises.