Thank you Brandi! So how does that work then when I have global and non global procedures being billed together with consultation codes? Like this one, which probably isn't a great example because that was the one that I thought the E/M should get a 57 and not a 25- right? And how's come she put a 57 on 45330 when that isn't a global? I'm confused.
44140-59
44139
45330-57
99223-25
Well, I imagine she only put the 57 modifier on there, because she didn't know that she couldn't; if a code doesn't start with 99XXX, you can't use a 57 or a 25 on there - maybe she meant to put a 59 modifier on 45330, since it has a 'separate procedure' designation. Let me ask, though: What happened in this encounter? I'm confused by the codes billed...It looks like the doc was consulted for a patient who was already in the hospital, and (if I'm correct), the doc decided to perform the procedures during that visit.
At some point, they performed a sigmoidoscopy, but it's not clear if that was done before, or after the other procedure.
The other procedures listed, represent an
open partial colotomy, with a take-down of the splenic flexure...right? Or was that done by scope, as well? If the colotomy was done laproscopically also, you'd need to use 44204, and 44213, instead.
Assuming that the colotomy was open, and the decision for surgery happened on that date, you'd bill it like this:
99223-57
45330-59
44140
44139...This code doesn't need a modifier, because it's an add-on code, meant to be used in conjunction with 44140.
If the colotomy was done by scope, then it will look like this:
99223-57
44204
44213
45330...this time, it doesn't look like it needs a 59 modifier, because it's not on the NCCI tables with 44204 or 44213 - but I might be wrong about that.
If the decision for surgery wasn't done that day, don't bill 99223 at all.
FYI: The 'Decision for surgery' modifier (57), means that, during that E/M encounter, the provider made the decision to perform a major surgery (eg, one with a 90 day global). Normally you see it on a day that comes before the surgery date, but it's also correct to use, if it's on the same date. Sometimes, you'll see it on a DOS prior to the surgery for minor procedures (0, 10 day globals) - and that's okay, too. You can use a 25 modifier on the same DOS as the surgery instead of the 57 modifier for major surgeries - it will probably pay if it's billed that way, but it's technically not correct.
*Note - The term "Global" comes from the 'global surgical package'...CPT defines some services as being incidental to surgical procedures, and they're described in the CPT under the surgery guidelines. The global days are a set period of time before and after the surgery, where any services related to the surgery (E/M - like the follow up visits), are considered 'bundled' into the surgery. Basically, they're saying "We already paid you a large amount of money to perform this surgery, and that includes any routine aftercare, for the next 90 days."
Unrelated E/M's after the date of the surgery, but within the global period (by the same doctor), need a 24 modifier attached, to process. For other surgical procedures (eg, CPT's that don't start with 99XXX) on the same date as the surgery may need a modifier, and they may not. It depends on CPT guidelines, and NCCI edits. Procedures after the surgery, but during the global period, will need either a 58, 78, or 79 modifier, depending on the circumstances. Does that clear up some of it for you?