tci ED Coding & Reimbursement Alert - 2022 Issue Q2

Use This Handy Tool to Differentiate Between Modifiers 25 and 57

Your modifier 25 claims should meet all of the following criteria: The E/M occurs on the same day as the procedure The procedure following the E/M is minor (has a zero- or 10-day global period) The E/M service is both significant and separately identifiable from any inherent preoperative E/M component that the procedure requires The same physician (or one with the same tax ID) provides the E/M service and the surgical procedure. Note that the diagnosis associated with the E/M service can be the same as the diagnosis associated with the same-day procedure. Or the diagnosis associated with the...

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