Primary Care Coding Alert

Feel free to report stress tests and E/Ms without modifier 25

CMS has issued a number of changes that will affect the way you should report--and be reimbursed for--many of your most frequently performed procedures. Here's the scoop on the changes your office needs to implement today. Change 1: Reserve 25 for E/Ms and Procedures With Globals Tired of trying to figure out when modifier 25 is required if you perform E/M services in addition to medicine services? Good news: CMS has finally issued a much-needed clarification.

As of Aug. 1, you should only use modifier 25 when your family physician provides a significant and separately identifiable E/M service on the same day as a procedure with a global period, says Jim Collins, CPC, CHCC, president of Compliant MD Inc. in Matthews, N.C.

Example: A family physician performs an established patient E/M service and a stress test during the visit. 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, Collins says. His rationale: -The stress test does not have a global period.-

The E/M service is significant and separately identifiable from the stress test, so you can still report both the E/M and stress test codes. You simply do not need to append modifier 25 to the E/M code.

To report the stress test, you should use one of the following codes depending on the physician's documentation:

- 93015--Cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous electrocardiographic monitoring, and/or pharmacological stress; with physician supervision, with interpretation and report

- 93016--- physician supervision only, without interpretation and report

- 93017--- tracing only, without interpretation and report

- 93018--... interpretation and report only. To code the E/M service, you should report the appropriate-level established patient code, for example, 99213 (Office or other outpatient visit for the evaluation and management of an established patient -) for a level-three E/M service.

Important: Check with your payers for their individually tailored modifier 25 policies. Some insurers may require modifier 25 on an E/M service charged in addition to a procedure with a zero-day global period, such as developmental screening (96110, Developmental testing; limited [e.g., Developmental Screening Test II, Early Language Milestone Screen], with interpretation and report).

For more: You can download the CMS clarification at www.cms.hhs.gov/transmittals/downloads/R954CP.pdf. Change 2: Report Same-Day Critical Care and Hospital Discharge In the most recent version of the National Correct Coding Initiative edits, version 12.2 (effective July 1, 2006), CMS deleted an edit that made critical care codes 99291-99292 components of hospital discharge day management code 99239 (Hospital discharge day management; more than 30 minutes). Now that CMS has [...]