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Printed Date: 9/22/2015
Denial Reason, Reason/Remark Code(s)
Additional Modifiers May Apply
When a visit occurs on the same day as a surgery with '0' global days and within the global period of another surgery and the visit is unrelated to both surgeries, CPT modifiers 24 and 25 must be submitted.
To determine the global period of a surgery, refer to the Medicare Physician Fee Schedule database (MPFSDB). Access the database directly from the CMS website.
Was the E/M service performed by the same physician within the global period of a surgery?
Was the E/M service performed by the same physician on the same day as a minor surgical procedure?
See CPT modifier 25 if the E/M service is significant and separately identifiable from the surgery (above and beyond the other service provided, or beyond the usual pre/post op care for the other procedure). If the E/M service is not over and above the usual preoperative and postoperative care associated with the surgery, the E/M service is not separately payable.
Did the E/M service result in a decision to perform major surgery (surgery with 90 follow-up days) that same day or the next day?
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Last Updated: 02/08/2018