W7021

FISS Narrative:
A medical visit billed on same day as a type T or S procedure without CPT modifier 25

Explanation and Suggestion:
Verify the code submitted, the OCE prohibits providers from billing an Evaluation and Management (E/M) procedure the same day as a surgical or significant procedure. If appropriate, add CPT modifier 25 and resubmit.

Change Request 1725 (PDF, 99 KB): Use of CPT modifier 25 and 27 in the Hospital Outpatient Prospective Payment System (OPPS), provides information regarding the use of CPT modifier 25 on an E/M code when it is reported with a procedure code that has a status indicator of S or T.

 

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