tci E/M Coding Alert - 2014 Issue 6

Reader Question: Make a Call to the Payer to Determine Whether E/M is Bundled With Surgery

Question: We had a patient present to the office for a relatively minor problem. Our doctor provided an E/M service and sent the patient home. Later, the same patient suddenly developed terrible pain. He contacted the same doctor who had him go to the hospital for an emergency procedure. The E/M deserves separate reimbursement, but I’m not sure which modifier to use. Modifier 57 is a decision for surgery and there was no decision for surgery during the initial office encounter. I want to use modifier 25 as the E/M was a separately identifiable service on the same...

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