As of 1/1/2022 the NCCI updated its definition of modifier 25 to specify that the E/M service must not only be separately identifiable and above and beyond what's included in the procedure, but also "unrelated." Our urologists are now being told they cannot bill a hospital consult, for example, if they also insert a stent or perform a ureteroscopy same day. This seems ludicrous. Any word on this? The word "unrelated" is specified on page 15. We are being told that Noridian is performing nationwide audits regarding modifier 25 and E/M services required to be completely "unrelated."
Page 15 states "If a procedure has a global period of 000 or 010 days, it is defined as a minor surgical procedure. In general, E&M services performed on the same date of service as a minor surgical procedure are included in the payment for the procedure. The decision to perform a minor surgical procedure is included in the payment for the minor surgical procedure and shall not be reported separately as an E&M service. However, a significant and separately identifiable E&M service unrelated to the decision to perform the minor surgical procedure is separately reportable with modifier 25."
The usual definition of modifier 25 is then posted on page 17, adding to the confusion. I really need clarification on this because otherwise our doctors will have to see the patient for an E/M and then schedule all minor procedures rather than working efficiently and performing them same day in order to get paid fairly for their work.
Page 15 states "If a procedure has a global period of 000 or 010 days, it is defined as a minor surgical procedure. In general, E&M services performed on the same date of service as a minor surgical procedure are included in the payment for the procedure. The decision to perform a minor surgical procedure is included in the payment for the minor surgical procedure and shall not be reported separately as an E&M service. However, a significant and separately identifiable E&M service unrelated to the decision to perform the minor surgical procedure is separately reportable with modifier 25."
The usual definition of modifier 25 is then posted on page 17, adding to the confusion. I really need clarification on this because otherwise our doctors will have to see the patient for an E/M and then schedule all minor procedures rather than working efficiently and performing them same day in order to get paid fairly for their work.