Friday, June 4, 2010

Evaluation/Management Code Modifiers

AI Principal Physician of Record. Used by the admitting or attending physician who oversees the patient's care, as distinct from other physicians who may be furnishing specialty care.
24 Unrelated E/M service by the same physician during a post op period - Use with E/M codes only to indicate that the E/M service was performed during a postoperative period for a reason(s) unrelated to the original procedure. Modifier 24 applies to unrelated E/M services for either MAJOR or MINOR surgical procedure. Failure to use this modifier when appropriate may result in denial of the E/M service.
25 Significant, separately identifiable - Evaluation and Management service by the same physician on the same day as the procedure or other service. The physician may need to indicate that on the day a procedure or service was performed, the patient's condition required a significant, separately identifiable E&M service above and beyond the other service provided or beyond the usual preoperative and postoperative care associated with the procedure that was performed. The E&M service may be prompted by the symptom or condition for which the procedure and/or service was provided. As such, different diagnoses are not required for reporting of the E&M services on the same date. This circumstance may be reported by adding the modifier -25 to the appropriate level of E&M service.
57 Decision for surgery - Use with E/M codes billed by the surgeon to indicate that the E/M service resulted in the decision for surgery (E/M visit was NOT usual preoperative care). For E/M visits prior to MAJOR surgery (90-day post op period) only. Failure to use this modifier when appropriate may result in denial of the E/M service.

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