© 2019 Palmetto GBA, LLC
We frequently update our articles to reflect the latest changes and updates to Medicare, and strongly recommend you visit this article at link below to confirm you have the latest version.
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?
We value your opinion and want to provide the highest-quality and most relevant Medicare knowledge possible. Please let us know if this article was helpful.
It didn't answer my question
This article was helpful
We’re glad we could help you today and appreciate your feedback. When you rate our articles as most helpful, we know that we are on the right track for providing you with important news and information.
We're sorry this article didn't help you today. We'll use your feedback to review this article to try to revise or expand it. Contact us with more feedback or a question on this topic.
Last Updated: 02/08/2018