Sunday, August 1, 2010

Evaluation and Management Code Modifiers


21 Prolonged Evaluation and Management (E/M) services - Use only with highest level of care code for the category when the face-to-face or floor/unit service provided is prolonged or otherwise greater than that usually required for the highest level code. No effect on payment. Informational only.
24 Unrelated E/M service by the same physician during a post operative 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 E/M service by the same physician on the same day of a procedure or other service - E/M service or 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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