Modifier 25 Continued: Billing an E/M visit and a Starred Surgical Procedure

Why This Topic Matters

Accurate reporting of same-day E/M and procedure services affects claim payment and compliance, especially when CPT and Medicare rules do not align. The article helps readers recognize when general billing assumptions may change based on payer policy and procedure type.

Article Sections

1. Same-day E/M and procedure billing in the emergency department

   Introduces the general issue of reporting evaluation and management services alongside procedures performed during the same encounter. Sets up the distinction between routine procedure billing and more specialized surgical scenarios.

2. Starred Procedures in CPT

   Describes the CPT framework for starred and non-starred surgical procedures and the broader concept of global surgical services. Explains that the article compares these concepts with the way payers view included services.

3. Medicare Caveat

   Summarizes the Medicare perspective on surgical packages and same-day E/M reporting. Focuses on the payer-specific nature of these rules and the need to consider whether the service is separately identifiable.

4. Use of the -25 Modifier vs. the -57 Modifier

   Compares the two modifiers in the context of emergency department surgical encounters. Highlights that the article discusses when each modifier is generally associated with different types of procedures and payer expectations.