Practice Management Alert

How you deal with global periods and modifier -25 is about to change.

In past CPT manuals, a star next to certain diagnostic tests and minor procedures has served as a "red flag" to alert you to short global periods (0-10 days), says Catherine Brink, CMM, CPC, president of HealthCare Resource Management Inc. in Spring Lake, N.J.

In 2004, CPT is taking off the stars, which means billing offices should take these three steps: 1. Look up every code's global package to determine the number of days in the global period so you know if you need to use modifier -25. 2. Be extra careful when using modifier -25 to report an E/M service the same physician provides to the same patient on the same day as any minor procedure. There must be a distinctly separate and documented E/M service for you to use this modifier with a procedure or diagnostic test. 3. The best way to secure payment, especially from Medicare, is to make sure your doctors are clearly documenting their E/M visits on the same day as procedures. When payers see modifier    -25, they're likely to return the claim and ask to see the documentation first.

Warning: The OIG has modifier -25 on its Work Plan and will be on the lookout for inappropriate usage