General Surgery Coding Alert

• The E/M service occurs during the postoperative period of another procedure
• The current E/M service is unrelated to the previous procedure
• The same physician (or tax ID) who performed the previous procedure provides the E/M.

Use modifier 25 if the claim meets all of the following criteria:

• The patient’s condition requires a significant, separately identifiable E/M service above and beyond the other service provided or beyond the usual preoperative and postoperative care associated with the [surgery]
• The separate E/M may be for a different condition (diagnosis) than the procedure, but not necessarily
• The same surgeon (or another surgeon with the same tax ID) provided the E/M service and the surgical procedure.

Use modifier 57 if the claim meets all of the following criteria:

• The E/M service directly prompted the surgeon’s decision to perform surgery
• The surgical procedure following the E/M has a 90-day global period
• The same surgeon (or another surgeon with the same tax ID) provided the E/M service and the surgical procedure.