Medicare Compliance & Reimbursement

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. Call on 57 for 'Major' Follow-up Procedures You should append modifier 57 (Decision for surgery) to an E/M service that occurs on the same day, or on the day before, a major surgical procedure, and which results in the physician's decision to perform the surgery. CMS guidelines identify a major surgical [...]