Modifier Cheat Sheet: Banish Your E/M Modifier Phobias Forever

Posted on 07. Aug, 2009 by Editor in Toolkit

Once you have this tool, you’ll never again wonder which modifier applies to minor vs. major procedures.

If you’re often mixing up your E/M modifiers, then print this post and hang it near your desk. You’ll be sure to apply the appropriate modifier every time.

Pick Modifier 24 for Post-Op Cases

When you report modifier 24 (Unrelated evaluation and management service by the same physician during a postoperative period), the E/M service must meet these criteria:

• The E/M service occurs during the postoperative period of another procedure.

• The current E/M service is unrelated to the previous procedure.

• The same physician (or tax ID or same group and specialty) who performed the previous procedure provides the E/M.

Red flag: This is true even if the two physicians have different specialties or sub-specialties.

WEBINAR: E/M for Ortho. Where are you losing money?

Equate Modifier 25 With Minor Procedures

Appending modifier 25 (Significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service) means the E/M service must meet these requirements:

• The E/M is significant and separately identifiable from any “inherent” E/M component included with other services/procedures you report on the same day. The office visit is not merely preoperative in nature or an integral part of the minor procedure.

• The E/M may be related or unrelated to other procedures/services you report on the same day.

• The service/procedure the surgeon provides on the same day as the E/M service should have a zero-day, 10-day or “XXX” global period.

• The same physician bills the E/M and other procedures/services on the same day. For instance, the most common use of modifier 25 is an office visit (99201-99215) in conjunction with an injection (20526-20612).

E/M Related to Major Procedure? Use Mod...

Tags: 99201, 99215, E/M, evaluation and management, global, modifier, modifier 24, modifier 25, modifier 57, postoperative, tax ID