Ob-Gyn Coding Alert

Reader Question:

Billing E/M Code With Starred Procedure

Question: Can we bill an E/M code with a starred procedure?

Sharon Wakeel
Fresno Womens Medical Group, Fresno, Calif.

Answer: When the physician provides a significant, separately identifiable evaluation and management (E/M) service over and above any procedure, you can bill the E/M code with a -25 (significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) or -57 (decision for surgery) modifier in addition to the procedure. When submitting to Medicare, use the -25 modifier when the procedure has a global period of less than 90 days and use the -57 modifier when doing a major procedure with a 90-day global period. When submitting to most commercial insurance carriers, use the -25 modifier with office procedures and the -57 modifier with hospital procedures. Be sure to place the -25 or -57 modifier on the E/M code.

The E/M service must be distinct and separately identifiable from the accompanying procedure. To clearly document the E/M service as distinct, you should make the notes for the procedure separate from the E/M note, meaning two complete notes, preferably on two pages with two signatures. Although it is not a requirement, you should use different diagnosis codes on the E/M and the procedure whenever possible.