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Wiki E/M on same date as Procedure
- Thread starter zaida120
- Start date
Teresa Collins
Guru
We do not have any problem with Medicare paying for E/M codes with modifier 25. We rarely have a case where we have to bill with modifier 57.
You might want to double check the ICD-9 code that is being used for the procedure.
Hope this helps!
Teresa Collins, CPC
You might want to double check the ICD-9 code that is being used for the procedure.
Hope this helps!
Teresa Collins, CPC
zaidaaquino
Guru
Hi, Zaida. My name is Zaida, too! 
Well, in regards to your question, once in a while we do get a denial. But as long as our documentation supports our charges, we appeal the denial. Do you have a specific example?
Zaida V. Aquino, CPC
Well, in regards to your question, once in a while we do get a denial. But as long as our documentation supports our charges, we appeal the denial. Do you have a specific example?Zaida V. Aquino, CPC
loughreykylene
New
We do not have any problems with medicare paying.
Modifier -25 is “significant, separately identifiable evaluation and management (E&M) by the same physician on the same day of the procedure.” It is E&M that resulted in a decision to perform a minor surgery. (10 day or less global days.)
Modifier -57 is “decision for surgery. (It is) an E&M service that resulted in the initial decision to perform the surgery. This modifier is used to report an E&M service that resulted in a decision to perform a major surgical procedure on the day of or the day before the surgery.”
(90 day global period procedures)
Source: Medicare Part B newsletter # 01-020, dated Sept.1, 2001, page 15. (PDF )
Hope this helps.
Modifier -25 is “significant, separately identifiable evaluation and management (E&M) by the same physician on the same day of the procedure.” It is E&M that resulted in a decision to perform a minor surgery. (10 day or less global days.)
Modifier -57 is “decision for surgery. (It is) an E&M service that resulted in the initial decision to perform the surgery. This modifier is used to report an E&M service that resulted in a decision to perform a major surgical procedure on the day of or the day before the surgery.”
(90 day global period procedures)
Source: Medicare Part B newsletter # 01-020, dated Sept.1, 2001, page 15. (PDF )
Hope this helps.