Part B Insider (Multispecialty) Coding Alert
Don't Use 25 Modifier For Procedure The Day After E/M Visit
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Leave HHA provider numbers off CPO claims
Do: When a patient comes in for an evaluation & management visit and then the physician decides to perform a minor procedure in the same session, you should go ahead and use the 25 modifier for the E/M visit, according to a new Frequently Asked Questions (FAQ) file from Part B carrier Palmetto GBA.
Don-t: But if the patient comes in for an E/M visit and then the doctor decides to bring the patient back the following day for a minor procedure, you shouldn't bill another E/M visit on the second day, Palmetto clarifies.
When using the 25 modifier, you should make sure the documentation shows that the patient's condition -required a significant, separately identifiable E/M service,- above and beyond the usual pre- and post-operative care, Palmetto adds. You don't need different diagnoses for the E/M visit and the procedure.
Note: For an E/M visit that resulted in the decision for surgery, you should use the 57 modifier instead, Palmetto points out.
Other recent FAQ answers:
- Don't include the provider number of the home health agency or hospice on your physician's Care Plan Oversight (CPO) services, or the carriers may deny the claims, warns CIGNA. Carriers no longer require the HHA or hospice's provider numbers.
- A physician's assistant (PA) can't bill incident to a physician's services in the Emergency Department setting, says Arkansas Medicare.
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