Reader Questions: Look to Global for Modifier Success

Why This Topic Matters

Correctly identifying when a visit and procedure can be reported separately affects claim accuracy and compliance. The article helps coders and billers understand the relevance of global period information and modifier selection in common same-day service scenarios.

Article Sections

1. Question

   Introduces a reader scenario involving an outpatient evaluation and management service occurring on the same day as a procedure. The question asks about separating the services on a claim.

2. Answer

   Provides a general response about reporting the services separately and references the types of codes and modifier considerations involved. It also points to where global period information may be checked.

3. Why 25?

   Explains the role of global surgical periods in determining whether a modifier may be appended to the evaluation and management service. The section discusses minor versus major surgery concepts at a high level.

4. There is another option for other circumstances, though.

   Notes that a different modifier concept applies in other same-day service situations involving major surgery. The section distinguishes between general scenarios without going into detailed selection logic.

5. Best bet: Check the Medicare Physician Fee Schedule (MPFS) for global period information on each CPT® code.

   Highlights a reference source for confirming global period information tied to procedure codes. The section emphasizes using fee schedule resources for verification.