tci E/M Coding Alert - 2013 Issue 5

Modifier 25 vs. Modifier 57

Your modifier 25 claims should meet all of the following criteria: The E/M occurs on the same day as the surgical procedure; The procedure following the E/M is minor (has a zero or 10-day global period); and The E/M service is both significant and separately identifiable from any inherent E/M component, and that the procedure involves the same physician (or one with the same tax ID) provides the E/M service and the subsequent procedure. Note that the diagnosis associated with the E/M service can be the same as the diagnosis associated with the same-day procedure, which means that the...

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