Internal Medicine Coding Alert

Published on Fri Sep 24, 2004 PDF

Question: Am I supposed to use modifier -25 when I bill an E/M service in addition to medicine services, such as EKG or spirometry?

Arkansas Subscriber

Answer: You should attach modifier -25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to E/M codes (99201-99205, 99211-99215) only when the other procedures or services you're billing have global days.
 
For instance, Arkansas' Medicare carrier, Blue Cross Blue Shield, states, "The physician should indicate by the use of this modifier [-25] that on the day a procedure with 0 global period (000), or a 10-day global period (010) or a 90-day global period (090) was performed, the patient's condition required a significant and separately identifiable E/M service above and beyond the other service provided or the usual pre- and postoperative care associated with the procedure performed."
 
Services such as electrocardiograms (for example, 93000, Electrocardiogram, routine ECG with at least 12 leads; with interpretation and report) and spirometries (94010, Spirometry, including graphic record, total and timed vital capacity, expiratory flow rate measurement[s], with or without maximal voluntary ventilation) carry no global days.