Date Issued: 1/1/2010
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One common error we encounter is the incorrect use — or lack — of modifiers. Evaluation and management (E/M) services rendered in conjunction with a surgical procedure are generally included in the global package. There are exceptions when the same physician (or the same physician group practice) performs unrelated E/M services during the global period. The global period assignment is the timeframe that applies to each procedure grouped in certain preoperative, same-day and postoperative services.
- Use modifier 24 to indicate the E/M is unrelated to the surgery during the postoperative period for a procedure that has either a 10- or 90- day global assignment.
- Use modifier 25 to indicate a significant, separately identifiable E/M on the day of a procedure or service that has a 0- or 10-day global assignment. The E/M service rendered has to be above and beyond the usual preoperative and postoperative care related to the procedure performed. The E/M can also be unrelated to the condition that prompted the procedure performed.
- Use modifier 57 to report an E/M service that results in a decision for surgery that has a 90-day global assignment.
Modifiers 24, 25 and 57 can only be appended to the E/M CPT procedure codes. Modifier exceptions may not apply to certain Correct Coding Initiative (CCI) claims rules. Appropriate documentation of the E/M services must be made available in the event of a review for claims using these modifiers.