Mc 025 sample 2024

Hi Everyone! Anna here with The Coding Guild! In today’s episode, we are going to quickly review what modifier 25 really is and how to know when we need it. Modifier 25, by definition, denotes a “Significant, separately identifiable Evaluation and Management service by the same physician or other qualified health care professional on the same day of the procedure or other service” Now the big question is, what counts as a ‘separately identifiable’ service? Separate from what exactly? The longer definition from Appendix A gives the following guidance: “It may be necessary to indicate that on the day a procedure or service was performed, the patient’s condition required a significant, separately identifiable E/M service above and beyond the other service provided or beyond the usual preoperative and postoperative care associated with the procedure that was performed.” We have a little more help here, so the E/M service must go above and beyond the other service provided. This part is easier to quantify. If there are 2 E/M services provided for example and one of them goes above and beyond the other one, they are not inclusive of each other, then we will be able to bill both of them, most of the time, with modifier 25. So the first part of the definition is understandable. But what is this 'beyond the usual pre-operative and postoperative care?' What counts as 'usual'? What belongs to a procedure? Is there any E/M associated with procedures? Is it what we are talking about here? Actually, yes. If you recall our global surgical modifier review, up in the corner and in the description below, procedures don’t stand on their own. Payment for them includes more than just solely the intervention performed. Full payment is given for: pre-operative care, intra-operative care and then post-operative care. All these 3 elements must be present to qualify for full procedural payment. Or to put it differently: there will...