tci General Surgery Coding Alert - 2003 Issue 5

Reader Question: Use -25 for E/M and Scope on the Same Day

Question: May we report a diagnostic endoscopy and E/M service on the same day? The payer keeps rejecting our claims. Arizona SubscriberAnswer: Yes, you may report both a diagnostic endoscopy and an E/M service on the same day, but only if you append modifier -25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to the E/M service, which must be demonstrably significant and separately identifiable from the "inherent" E/M service included in the scope. CMS policy dictates that all procedures, from simple injections to common diagnostic...

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