Advanced Search

Ob-Gyn Coding Alert

Clip-and-Save Checklist:

Your Modifier Decision-Maker

Published on Thu Jan 01, 2004

Choosing whether to use a modifier (either -25 or     -57) can mean the difference between getting paid for your E/M service or settling for just the procedure fee. Judy Richardson, RN, MSA, CCS-P, a senior consultant at Hill and Associates in Wilmington, N.C., offers this handy checklist:

 

  •  Report both the E/M service and the procedure code if:
      
    - The ob-gyn decides to perform the procedure at   the same encounter as the E/M service, regardless of the diagnosis (use modifier -57 for major procedures [>90 global days] or modifier -25 for  minor procedures [<90 global days])
      
    OR
      
    - The E/M service and the procedure have different diagnoses (append modifier -25 to the E/M code with a minor procedure or modifier -57 for a major procedure).

     

  •  Report only the procedure code if:

     - The ob-gyn decides to perform the procedure at a different encounter than the one during which he performs the procedure
      
    OR
      
    - The E/M service did not require a significant history, physical exam and/or medical decision-making.

    • Other Articles in this issue of

    Ob-Gyn Coding Alert

    View All