Pulmonology Coding Alert

Learn why 24 and 57 are most likely not appropriate modifiers

When you need to report an E/M service with a pulmonology procedure, you'll most likely consider three modifiers: 24, 25 and 57. To make that job easier, you should follow these expert tips to learn how global periods affect your modifier use. Pay Attention to Each Modifier's Rule of Use You may find that deciding among modifiers 25, (Significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service), 24 (Unrelated E/M service by the same physician during a postoperative period) and 57 (Decision for surgery) is confusing because you can append all three to E/M codes. Yet, remember that 25 is almost always the correct modifier for pulmonology coders to use, says Carol Pohlig, BSN, RN, CPC, senior coding and education specialist at the University of Pennsylvania department of medicine in Philadelphia.

You should not append modifiers 24 and 57 to E/M services that pulmonologists perform because of the global-period restrictions on the modifiers, Pohlig says. The global-surgical-package rules bundle services (including E/M services) typically associated with the surgical procedure into the surgical procedure. You can use modifiers 24, 25 and 57 to appropriately overcome bundles, but each of these modifiers has different rules of use. Use Modifier 25 in Most Cases When your physician performs an E/M service and then a pulmonology procedure, your challenge is to figure out if carriers permit you to report both services. Most common pulmonology procedures, such as bronchoscopies and thoracentesis, carry a zero-day global period, Pohlig says.

All E/M services provided pre- or postoperatively that are related to these procedures and that your physician performs on the same day are bundled into the procedure. This means that, when applicable, you need to use modifier 25 to report a separate E/M service. Modifier 25 is the only modifier you can use to report a significant, separately identifiable E/M service your physician performs on the same day as a bronchoscopy or a thoracentesis.

Example: An established patient presents to your practice with severe coughing and chest pain. Your pulmonologist performs an evaluation and orders a chest x-ray, which reveals a pleural effusion. He then decides to perform a thoracentesis procedure on the same day.
 
To capture payment for both the office visit and the procedure, report 99213 (Office or other outpatient visit for the evaluation and management of an established patient ...) for the E/M service and 32000 (Thoracentesis, puncture of pleural cavity for aspiration, initial or subsequent) for the procedure. Attach modifier 25 to 99213 to indicate that the visit was a separately identifiable service during which the physician decided to perform the procedure.

Assign chest pain (786.50) [...]