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tci Medicare Compliance & Reimbursement - 2011 Issue 21

Part B Mythbuster: Same-Day E/M Visit? Modifier 25 May Not Always Be Your Best Bet

Keep E/M documentation apart to demonstrate the service's 'separate' status. When you report an E/M service that prompts a follow-up procedure, you may be accustomed to always reaching for modifier 25. That, however, may be incorrect coding. In reality, to report an E/M service that prompts a follow-up procedure, you'll typically choose from either modifier 25 or modifier 57. Which modifier you select, however, depends not only on the nature of the E/M service but also on the length of the global period associated with the follow-up procedure. Here are the facts you'll need to make the choice easy...

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