tci ED Coding & Reimbursement Alert - 2001 Issue 5

Reader Question: Modifier -25

Question: When is it appropriate to code an initial E/M (for a new patient) without the -25 modifier when a procedure is performed on the same day? Please comment on the minor procedures versus the global. I would appreciate clarification on the difference between CPTs rules and HCFAs rules. Ohio SubscriberAnswer: ED visits do not distinguish between new or established patients or initial or subsequent services. According to CPT, minor procedures do not include the pre- or postoperative service. Therefore, the examination to identify the injury and type of operative procedure to be performed is a separate service. Medicare...

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