Wiki Modifier 25 - Does anyone know if modifier 25

[Alisa Dinneen]

Does anyone know if modifier 25 needs to be attached to an E/M when the procedure done does not have global days attached? An example would be CPT codes 99212 and 51798 ("global concept does not apply to the code.").

All I can find are references to "minor" procedures with globals of 0 or 10 days.

Thank you,
Alisa

 

[Karolina]

Modifier 25 is attached to a separately identifiable E/M code regarless if the procedure has a global period or not. It is important that the E/M code is a significant, separate service from the procedure, because some basic E/M is usually required as part of the procedure

 

[pamtienter]

You shouldn't need a 25 modifier on the E/M if the global days concept doesn't apply to the procedure. If it doesn't appy, that means there is no E/M component built into the procedure code so an E/M would be allowed to be billed separately. When there is a global day assignment, that means the evaluation and management portion was built into the consideration for the RVU assignment of the code. When you are billing a separate E/M with the 25 modifier, you are saying you have a separately identifiable service from the E/M built into the procedure code.

 

[belindapearl]

Per AMA coding book modifier 25 is to be used to indicate that on the day a procedure or service (no global for service codes) was performed a seperate and identfiable E/M service above and beyond the other service provided OR beyond the usual preoperative and postoperative care associated withe the procedure was performed. So yes you would need modifier 25 when an E/M service was performed regardless of global days.

An example would be if patient is there for their yearly physcial and also to have their sore throat checked it would be billed as such
99212-25
99395

Preventative medicine has no global days, but you have to use the 25 modifier to indicate that you had a seperate and identifiable E/M on the same day.