Part B Insider (Multispecialty) Coding Alert

Published on Fri Mar 02, 2012 PDF

When appending modifier 25, the E/M service must meet these requirements:

• The E/M is significant and separately identifiable from any "inherent" small E/M component that you should consider part of the minor services/procedures you report on the same day.
• The E/M may be related or unrelated to other procedures/services you report on the same day.
• The E/M may be for a totally unrelated reason, or
• The E/M may be for the same reason the service/procedure is being performed, but the service/procedure was not pre planned and the it was determined to perform the service/procedure as part of the E/M
• The service/procedure the surgeon provides on the same day as the E/M service should have a 0-day, 10-day or "XXX" global period.
• The same physician bills the E/M and other procedures/services on the same day.