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E/M on same date as Procedure

  1. Default E/M on same date as Procedure
    Medical Coding Books
    Does anyone have trouble getting medicare to pay on an E/M code on the same date as procedure with modifiers 25 and 57?
    Be Blessed!
    Zaida D. McGarry, CPC

  2. #2
    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

  3. #3
    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

  4. Default
    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.

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