Otolaryngology Coding Alert

Primary-procedure global days can guide you to correct application

You should append modifier 25 only if the E/M service is done with a minor surgical procedure (that is, a procedure with a zero- or 10-day global period) and if the E/M service does not occur during the global period of a previous procedure.

Watch out: Medicare, and other payers that follow National Correct Coding Initiative edits, also treats all procedures with an -XXX- global period as -minor- procedures.

For an E/M service that occurs the day of or day before a major surgical procedure (a procedure with a 90-day global period), you should append modifier 57 (Decision for surgery) rather than modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service).

Likewise, for an unrelated E/M service during the global period of a previous procedure, you should turn to modifier 24 (Unrelated evaluation and management service by the same physician during a postoperative period), says Linda Parks, MA, CPC, CCP, coding specialist in Marietta, Ga. You may not separately report related E/M services during the global period of a previous procedure.

Get all the facts: For more about modifiers 24 and 57, see -Pick the Correct E/M Modifier Every Time: Here's How- in the November 2005 Otolaryngology Coding Alert.

Next month: All about modifier 78 (Return to the operating room for a related procedure during the postoperative period) and a handy chart to help you decide among modifiers 24, 25, 57 and 78.