Modifier Cheat Sheet: Banish Your E/M Modifier Phobias Forever

Once you have this tool, you’ll never again wonder which modifier applies to minor vs. major procedures.

If you’re often mixing up your E/M modifiers, then print this post and hang it near your desk. You’ll be sure to apply the appropriate modifier every time.

Pick Modifier 24 for Post-Op Cases

When you report modifier 24 (Unrelated evaluation and management service by the same physician during a postoperative period), the E/M service must meet these criteria:

• The E/M service occurs during the postoperative period of another procedure.

• The current E/M service is unrelated to the previous procedure.

• The same physician (or tax ID or same group and specialty) who performed the previous procedure provides the E/M.

Red flag: This is true even if the two physicians have different specialties or sub-specialties.

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Equate Modifier 25 With Minor Procedures

Appending modifier 25 (Significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service) means the E/M service must meet these requirements:

• The E/M is significant and separately identifiable from any “inherent” E/M component included with other services/procedures you report on the same day. The office visit is not merely preoperative in nature or an integral part of the minor procedure.

• The E/M may be related or unrelated to other procedures/services you report on the same day.

• The service/procedure the surgeon provides on the same day as the E/M service should have a zero-day, 10-day or “XXX” global period.

• The same physician bills the E/M and other procedures/services on the same day. For instance, the most common use of modifier 25 is an office visit (99201-99215) in conjunction with an injection (20526-20612).

E/M Related to Major Procedure? Use Mod 57

To properly append modifier 57 (Decision for surgery), remember these points:

• The E/M service must occur the day of or the day before a major surgical procedure (a procedure with a 90-day global period).

• The E/M service must prompt the surgical procedure that follows.

• The E/M service must be related to the procedure that follows.

• The same physician (or tax ID) provides the E/M service and the surgical procedure.

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