Wiki Modifer -25 with -57??

[mlblake]

Our office has been advised by two different insurance companies that from now on when an e/m service is performed on the same day as a major surgery (and the decision for surgery was made on that same day) we now have to append BOTH -25 and -57 modifiers. They are saying that -57 is "informational" only whereas -25 drives the separation between the e/m and the surgery.

I have not heard this before and I was taught that these two modifiers do not get billed together. -25 is for e/m with a minor procedure and -57 is for e/m with major surgery.

Am I incorrect? Has anyone else come across this issue?

Thanks for any help!

 

[solocoder]

I too would love to know if 25 and 57 can be used together, but for a different scenario. Doctor performs one procedure with a 90 global AND a procedure with no global, on the same day as an e/m service.

 

[aaron.lucas]

It may be that the insurance companies' software is programmed to only recognize the 25 to override NCCI/Global edits? It's possible that they programmed the -57 to just be informational, and programmed the 25 to trigger reimbursement. It's not really correct, but that could be what they are talking about. Does that make sense?

 

[mlblake]

Yes, that does make sense. Thank you for the input! I just can't stand to code incorrectly just to appease an insurance company. But I guess we have to do what we have to do!

Thanks again!

 

[tjrice]

Yes, that does make sense. Thank you for the input! I just can't stand to code incorrectly just to appease an insurance company. But I guess we have to do what we have to do!

Thanks again!

Thank you for your views on the subject of these modifiers. 3rd party payers can and will force coders to re-think and shift their paradigms. Correct coding, while a noble pursuit, can become relative to how a payer processes claims. Very good thread!