We are updating our compliance program and we have come across some discrepancies in regards to -25 use with New Patients and minor procedure with 0 global days.
Referencing the NCCI Policy Manual for Medicare Services, E&M Services page 17 paragraph 5:
If a procedure has a global period of 000 or 010 days, it is defined as a minor surgical procedure. In general E&M services on the same date of service as the minor surgical procedure are included in the payment for the procedure. The decision to perform a minor surgical procedure is included in the payment for the minor surgical procedure and should not be reported separately as an E&M service. However, a significant and separately identifiable E&M service unrelated to the decision to perform the minor surgical procedure is separately reportable with modifier 25. The E&M service and minor surgical procedure do not require different diagnoses. If a minor surgical procedure is performed on a new patient, the same rules for reporting E&M services apply. The fact that the patient is “new” to the provider is not sufficient alone to justify reporting an E&M service on the same date of service as a minor surgical procedure. NCCI contains many, but not all, possible edits based on these principles.
MLN MM2025 updated 11/1/2012
Physicians and qualified nonphysician practitioners (NPP) should use CPT modifier -25 to designate a significant, separately identifiable E/M service provided by the same physician/qualified NPP to the same patient on the same day as another procedure or other service with a global fee period.
AAPC CPT Manual 2016
References the above MLN stating a -25 does not need to be appended on EM for any procedure with a 0 global day.
It seems the MLN conflicts with the NCCI policy re procedures that have 0 global days ie: 11100. Does anyone have any insight into this? Are you coding New E&M with this code?
Referencing the NCCI Policy Manual for Medicare Services, E&M Services page 17 paragraph 5:
If a procedure has a global period of 000 or 010 days, it is defined as a minor surgical procedure. In general E&M services on the same date of service as the minor surgical procedure are included in the payment for the procedure. The decision to perform a minor surgical procedure is included in the payment for the minor surgical procedure and should not be reported separately as an E&M service. However, a significant and separately identifiable E&M service unrelated to the decision to perform the minor surgical procedure is separately reportable with modifier 25. The E&M service and minor surgical procedure do not require different diagnoses. If a minor surgical procedure is performed on a new patient, the same rules for reporting E&M services apply. The fact that the patient is “new” to the provider is not sufficient alone to justify reporting an E&M service on the same date of service as a minor surgical procedure. NCCI contains many, but not all, possible edits based on these principles.
MLN MM2025 updated 11/1/2012
Physicians and qualified nonphysician practitioners (NPP) should use CPT modifier -25 to designate a significant, separately identifiable E/M service provided by the same physician/qualified NPP to the same patient on the same day as another procedure or other service with a global fee period.
AAPC CPT Manual 2016
References the above MLN stating a -25 does not need to be appended on EM for any procedure with a 0 global day.
It seems the MLN conflicts with the NCCI policy re procedures that have 0 global days ie: 11100. Does anyone have any insight into this? Are you coding New E&M with this code?