You Be the Coder: Don’t Use Modifier 25 With Minor Global Period

Why This Topic Matters

Accurate reporting for surgery-related E/M services depends on matching the E/M modifier to the procedure’s global period and on selecting the correct procedure code configuration. This article helps coders understand why a claim may deny when the wrong modifier or separate procedure coding approach is used.

Article Sections

1. Question

   A coding scenario is presented involving an office evaluation and osteotomy services performed during the same encounter. The question asks how the encounter should be reported after a denial.

2. Answer

   The response outlines the general resubmission approach and identifies the appropriate relationship between the procedure reporting and the E/M service. It also notes that the modifier initially used was not the correct one for the encounter.

3. Explanation

   This section discusses the broader rationale for grouping the osteotomy services and addresses the modifier selection issue in relation to the procedure’s global period. It compares the scenario to other osteotomy reporting situations and clarifies the type of E/M modifier involved.