By recei What is modifier 25?
- Modifier 25 is a way to identify a “significant, separately identifiable evaluation and management service given by the same physician or other qualified health care professional (QHP) on the same day of the procedure or other service. Modifier 25 need to be appended to evaluation and management services only. The E/M service must be significant and separately identifiable, and the extended E/M work was not medically necessary.
Uses of modifier 25 global period
- Modifier 25 is appropriate when an E/M service is provided on the same day as a minor procedure (0-10 days global period)
- Do not use modifier 25 if billing is required for services performed during a postoperative period and is related to the previous surgery. For an unrelated E/M service during the global period of a previous procedure, you must report modifier 24 which says Unrelated evaluation and management service by the same physician during a postoperative period.
- Modifier 57 is appropriate when an E/M service prompts the decision to render a major procedure (90 days global period) within 24 hours of the E/M service.
Global period
Per national Correct Coding Initiative (CCI)
Major procedure: A procedure with a 90-day global period “is defined as a major surgical procedure.” To clearly state the major surgery, it has been extended to 92 days which include one day before the day of the surgery, the day of surgery, and the 90 days immediately following the day of surgery or service.
Minor procedure: A procedure with 0-10 days global period “is defined as a minor procedure
Phases of Global Surgery
The Global Surgery is divided into three phases:
- Preoperative evaluation
- Intraoperative procedure
- Postoperative care
Also read: LCD vs NCD