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E/M service prior to minor surgical procedure


Best answers
CMS makes it clear that a visit is not billable on same DOS as a minor procedure unless it is "significant, separately identifiable." They clearly state the rule as applying only to visits on the same day. Does anybody know if this rule applies to visits on the previous DOS? We have a group for whom it is not unusual to perform a visit late one evening and then perform the minor procedure early the following morning. Ethically, I'm of the opinion that we should follow CMS guidelines for same DOS, but I want something concrete to show our docs.


True Blue
Local Chapter Officer
New Windsor, New York
Best answers
Follow the rules for modifier -25 - after all, that is where you find the language for "significantly separately identifiable." If you meet this, DOS doesn't matter. Also, here is the other part of this -when the patient returns the next day for the procedure - is there an E/M service documented that is part of the procedure? Since all procedures do have an E/M element built in, if this isn't performed when the patient comes back then the service the previous night could be considered part of the procedure. However, I have not found anything specifically about -25 and the day before a minor procedure.