decisionhealth Newsletters, Coder Pink Sheets - 2009 Issue 2 (February)
ACOG: Append 25 to E/M done same day as diagnostic test
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Article Overview
This article summarizes an ACOG Practice Management and Coding Update addressing same-day evaluation and management services and diagnostic testing in obstetric and gynecologic practice. It explains why the guidance is relevant to claim submission, how payer policies have influenced common billing practices, and what general considerations are discussed for distinguishing a separate E/M service from routine test-related follow-up. The piece is useful for OB/GYN coders, billers, and clinicians who need to understand the broader policy context surrounding E/M services, diagnostic tests, and modifier usage.
Why This Topic Matters
Same-day E/M and diagnostic testing claims are a common source of denials and payer confusion. Understanding the general policy context helps practices review documentation and submission workflows before claims are sent.
What You Will Learn
- How ACOG discusses same-day E/M services and diagnostic testing
- Why payer policy differences can affect claim submission
- What general issues are considered when determining whether an E/M service is separate from test-related care
- How the article frames the role of modifier usage in reducing denials
Who Should Read This
- Obstetrician-gynecologists
- Medical coders
- Medical billers
- Practice managers
- Revenue cycle staff
Codes Discussed
Modifiers Discussed
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