Ob-Gyn Coding Alert

Question: A patient came in for diagnosis code 626.2 (excessive or frequent menstruation),CPT 99204 (office or other outpatient visit for the evaluation and management of a new patient) plus diagnosis code 622.7 (mucous polyp of cervix), CPT 56351 (hysteroscopy, surgical; with sampling [biopsy] of endometrium and/or polypectomy, with or without D & C). Do you use a modifier on the 99204?

Barbara Detwiler, RN
Jefferson Healthcare, PA

Answer: Anytime you provide a significant, separately identifiable evaluation and management (E/M) service at the same time a procedure is performed, you would bill the E/M service with a modifier -25 (significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service). When the E/M service also addresses the decision for major surgery (90-day global) that will be performed the same or next day, use modifier -57 (decision for surgery) on the E/M service instead.