Wiki Using Modifier 25 in a global period

[shortee3810]

First visit dx established left CTR and Trigger Finger and then MD performed a CTS Release, so the MD tried to get paid for 99213-25 within the global period of the CTS for the trigger finger. Aetna denied the claim, so we are curious why? Is it because the dx was established during the first visit? We know that the modifier 25 is under scrutiny because they say the MD over use it. We would like to know from a coding standpoint the guidelines regarding this.

Thanks

 

[amyjph]

If the patient is in a global surgery period for the Carpal Tunnel Release and is seen during the global of that for the Trigger Finger, Modifier 25 will not do anything.
Go to Appendix A of the CPT book and read the information for Modifier 24 and Modifier 25. This is what I would consider basic coding concepts. Also, look up the global surgical period for the 64721. CPTs can be searched here: https://www.cms.gov/medicare/physician-fee-schedule/search

Additional 24 & 25 info:

Modifier 24 Fact Sheet

www.novitas-solutions.com

Modifier 25 fact sheet

www.novitas-solutions.com

Edited to add: The documentation for the office visit E/M for the trigger finger must support appending the modifier and justify a separate E/M. For example, if the patient came in during the global for a f/u on the CTR; in passing the provider added, "hey how's your trigger finger?" and the patient said, "better". That is not enough. The MDM or time elements for the trigger finger alone would have to be enough to support an E/M.