Here's How to Keep Your E/M Modifiers Straight

Why This Topic Matters

Correct E/M modifier selection affects whether an evaluation and management service is reported separately or bundled into a surgical package. The article helps readers understand the general scenarios where modifier choice can affect claim accuracy and reimbursement.

Article Sections

1. Does the E/M Follow Another Service?

   Introduces the relationship between an evaluation and management service and a prior procedure or postoperative period. The section focuses on when a service occurs after another event and how that affects reporting.

2. Modifier 24: Conditions for Use

   Summarizes the general circumstances associated with reporting an E/M service during a postoperative period. The section presents broad criteria tied to timing, relationship to the prior procedure, and the physician relationship.

3. Major- or Minor- Procedure?

   Explains how the timing of an E/M service relates to a subsequent procedure and how global period length affects modifier selection. The section compares major and minor procedure scenarios at a high level.

4. Modifier 25: Conditions for Use

   Outlines the general conditions associated with same-day E/M reporting when another service or procedure is also provided. The section addresses broad requirements connected to significance, separateness, and procedure timing.

5. 90-Day Global = Modifier 57

   Describes the scenario involving a major surgical procedure and the decision-making visit that precedes it. The section references Medicare guidance and the relationship between the visit and the surgical decision.

6. Modifier 57: Conditions for Use

   Summarizes the general timing and relationship criteria associated with an E/M service that leads to a major surgical procedure. The section focuses on the broad circumstances surrounding the visit and the surgery.