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25600 with E/M

Loni Posted Thu 02nd of April, 2020 09:18:13 AM
Patient with a wrist fracture presents to the office. Can an E/M for the office visit be billed with the fracture care? And, does it make a difference if the patient is new or not? In other words, would either of these scenarios be appropriate? 99203-57 with 25600 and/or 99213-57 25600? We're getting conflicting information about whether to bill an E/M for the initial treatment of fractures. Thank you!
SuperCoder Answered Fri 03rd of April, 2020 08:06:45 AM

Hello Loni,

Thank you for your question.


If an evaluation and management service is provided on the same day as fracture care (which is the case as per the above provided documentation), modifier 57 (Decision for surgery) must be appended to the E&M code.


Note: If a patient is seen for the first time or an established patient is seen for a new problem and the 'decision for surgery' is made the day of the procedure or the day before the procedure is performed then the provider can report both the procedure code and an E/M code, using modifier 57 on the E&M code. The E&M service must meet the documentation guidelines for the level of service reported.


For more details, kindly refer the below CMS link:

Under heading: PRE-OPERATIVE PERIOD BILLING (Page 10 of 19)


Hope that helps!


Loni Posted Fri 03rd of April, 2020 09:09:09 AM
This is excellent! Thank you for your help!
SuperCoder Answered Mon 06th of April, 2020 01:33:01 AM

Thank you, happy to help.

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