Part B Insider (Multispecialty) Coding Alert

Published on Fri Jul 12, 2013 PDF

When CMS sends out a "reminder" about appropriate billing practices, you know you should listen.

Last week, the agency published MLN Matters article SE1323, which "reminds providers of the global surgery period" and urges practices to review the rules for how to bill E/M services in these situations. RAC auditors found errors for E/M billing during all of the global periods, from 0 to 90 days, the article notes.

Always remember that E/M services that you perform during the global period which are related to the surgery are included in the global payment, and are not separately billable even if you add a modifier such as 24 (Unrelated E/M Service by same physician or other qualified healthcare professional during postoperative period) or 25 (Significant, separately identifiable E/M service by the same physician or other qualified healthcare professional on the same day of the procedure or other service). Therefore, before appending one of these modifiers, confirm that you are actually providing an E/M service that falls under the guidelines of the modifiers, and that the E/M is unrelated to the surgery (modifier 24) or significant and separately identifiable and performed on the same date (modifier 25).

To read the complete CMS article, visit www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/SE1323.pdf.