Orthopedic Coding Alert

Choosing whether to use modifier 25 or 57 can mean the difference between getting paid for your E/M service or settling for just the procedure fee. Try this handy checklist to get your coding right every time: 1. Report both the E/M service and the procedure code if: - The physician 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). 2. Report only the procedure code if: - The physician decides to perform the procedure at a different encounter than the one during which he performs the E/M service OR - The E/M service provided did not require a separate and significant history, physical exam and/or medical decision-making.