tci General Surgery Coding Alert - 2009 Issue 4

Reader Questions: Prove Separate Service Before Billing E/M in Global

Question: If my doctor is charging an E/M and a FNA, is modifier 59 appropriate? Our payer is denying the claim for an improper modifier. California Subscriber Answer: Most payers, including Medicare carriers, require modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) on minor procedures. You should consider procedures with a zero- or 10-day global period as minor procedures. Caution: Don't just put a modifier on your E/M visit code to get paid. Make sure your E/M is a significantly, separately identifiable service from...

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