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Pulmonology Coding Alert

Reader Question:

Using Modifier -25

Published on Wed Aug 01, 2001

Question: When can I bill multiple procedures without modifier -25?

Colorado Subscriber
 
Answer: It is a "correct coding" principle to append modifier -25 (significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service) to an E/M service performed on the same day as a procedure. Medicare guidelines only require application of the modifier to an E/M service when reported on the same day that a minor procedure (with a 0- or 10-day global period) is performed. A "minor" procedure is identified by its global period, 0 or 10 days. A global period is a period of time assigned to a procedure or service that includes all preprocedure, intraprocedure and postprocedure care. Payment for a procedure covers all of this care. Care for problems not related to the procedure can be reported during a global period as long as the care is separate and identifiable from the reason for the procedure: e.g., subsequent hospital care involving asthma management is a separately reportable service for a patient who received a bronchoscopy for dyspnea. 
 
Note: Modifier -24 (unrelated evaluation and management service by the same physician during a postoperative period) is appended to an E/M service when reported on any postprocedure day during a 10-day global period. Assignment of global-period days can be found within Addendum B of the Health and Human Services section of the Federal Register. You can access this at www.gpo.gov/su_docs/aces/aces140.html.
 
In October 2000, the national Correct Coding Initiative version 6.3 identified a new list of procedures (with no applicable global period) that would require modifier -25 to be appended to an E/M service if performed on the same date. A memorandum put out by the Centers for Medicare & Medicaid Services (CMS, formerly HCFA) temporarily suspended these edits stating that some may be put into effect after July 1, 2001. In light of these developments, you should practice according to CPT standards and append modifier -25 in all cases where a separately identifiable E/M service is provided on the same day as a minor procedure or a procedure that has no applicable global period.

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