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Stenting Procedure on the Same day and an E&M

Leorah Posted Sun 18th of August, 2019 04:28:20 AM
Our dr.'s provided an E&M on the same day as the stenting procedure but was not related to the stenting. Would I append a 24 and 25 modifier to the E&M? Thanks
SuperCoder Answered Mon 19th of August, 2019 11:12:35 AM

Hi,

Thanks for your question.

When you report modifier 24, 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.

–The patient’s diagnosis documented must meet medically necessity for the visit.

Modifier 25 suggests when the medical documentation has to justify performing the separate E/M service. The patient’s condition may warrant the same provider performing a separate E/M service and another service or procedure on the same day.

Since, the procedure was performed on the same day of stenting procedure modifier 25 is appropriate to use.

Hope this helps.

Thanks.

Leorah Posted Tue 20th of August, 2019 12:52:58 PM
Thanks but let's say both those modifiers apply, can I code both modifiers?
SuperCoder Answered Wed 21st of August, 2019 08:56:10 AM

Hi,

Modifier 24 and 25 can be billed together with E/M code but the documentation must suggest the use of both the modifiers. As, in above situation modifier 24 can be appended with E/M when physician perform unrelated E/M service during postoperative period. If during the unrelated E/M visit the physician performs another procedure then modifier 25 can also be appended with E/M.

Hope this helps.

Thanks.

Leorah Posted Sun 08th of September, 2019 04:33:28 AM
In the case that I mentioned which is a stent procedure that takes place on the same day as another E&M should I bill both 24 and 25 modifier?
SuperCoder Answered Mon 09th of September, 2019 10:42:02 AM

 Hi,

As already stated modifier 24 and 25 can be billed together with E/M code but the documentation must suggest the use of both the modifiers.

In the scenario mentioned above, it is appropriate to append modifier 24, since the patient had an unrelated E/M service by the same physician or other qualified health profession during post operative period. 

Hope this helps.

Thanks.

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