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Appending Modifier 25

Should you bill an evaluation and management code every time you bill a minor procedure?

The decision to perform a minor procedure or endoscopy includes the E&M service on the same date of service and should not be reported separately. Minor procedures usually have a global period of 010 days or 000. Endoscopies have a global period of 000 days. 000 day global packages do not have pre-operative or post-operative days and generally the visit on the same day is not payable. The same applies to a 010 day global package except for the 10 day global post-operative days. However, there are exceptions as described in the National Correct Coding Initiative Policy Manual.

If a New Patient presents with head trauma and requires sutures and the provider confirms the allergy and immunization status, obtains consent and performs the repair, an E&M service is not separately reported. If the physician performs a medically reasonable and necessary full neurologic exam, an E&M may be reported separately. The same concept applies when an orthopedic provider supplies an injection to a specific joint. If the patient previously had an injection and the injection was planned, then no separate E&M is reported. If the patient has not had a previous injection and the provider is doing a detailed exam of other organ systems to determine the cause of the problem and orders an x-ray, prescribes medication or orders physical therapy, the appropriate E&M would be coded. It is not necessary to have a separate diagnosis to code both the E&M and the procedure.

Remember – just assessing the site, explaining what to expect during the procedure and obtaining an informed consent does not constitute a separate E&M. Please don’t hesitate to contact Precision if you have any questions relating to proper usage of Modifier 25.