decisionhealth Newsletters, Answer Books - 2011 Issue 9 (September)
Modifier 25 vs. 57 / Pay attention to the global when choosing 25 or 57 for in-office procedures
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Article Overview
This article reviews the relationship between modifier 25 and modifier 57 in the context of office procedures and global periods. It is intended for coding professionals who need to understand Medicare-oriented guidance on when an evaluation and management service may be separately reported alongside a procedure, and how the procedure’s global period affects that choice. The article includes a brief discussion of common procedural examples and the general distinction between minor and major surgical globals.
Why This Topic Matters
Correct modifier selection affects compliant reporting of evaluation and management services with procedures, especially when global period rules come into play. The article helps readers focus on the procedure’s global days rather than the site of service when evaluating modifier use.
What You Will Learn
- How procedure global periods relate to modifier selection for office-based services.
- How Medicare guidance distinguishes between minor and major surgical globals in this context.
- What general factors are discussed when an evaluation and management service is reported with a procedure.
- The relevance of office setting versus global period in modifier choice.
Who Should Read This
- Medical coders
- Coding auditors
- Billing staff
- Physician practices
- Compliance professionals
Codes Discussed
Modifiers Discussed
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