Podiatry has been, and continues to be, a highly audited medical specialty. The number one audit issue is the billing of an E/M service with a 25 modifier, thus it is imperative to understand the appropriate use of the 25 modifier.
The 25 modifier is used to demonstrate that a SIGNIFICANT, SEPARATELY IDENTIFIABLE Evaluation and Management (ie. E/M) service was performed on the SAME day of a MINOR surgical procedure (postoperative global period of 0 or 10 days) by the SAME physician.
An INITIAL patient E/M service can be billed when performed on the SAME date of service as a MINOR surgical procedure. The diagnosis code for the initial E/M service and the diagnosis code for the minor surgical procedure CAN be the SAME.
An ESTABLISHED patient E/M service CAN be billed when performed on the SAME date of service as a MINOR surgical procedure. The diagnosis code for the established E/M service MUST be DIFFERENT from the diagnosis code for the minor surgical procedure. There can be absolutely, positively NO correlation between the E/M service and the minor surgical procedure.
If an established patient is seen for a NEW problem that the patient has NEVER been evaluated for previously and a MINOR surgical procedure is performed on the SAME date of service, then not only can BOTH the established patient E/M service AND the minor surgical procedure be billed for, but the diagnosis code for the E/M service AND the diagnosis code for the minor surgical procedure CAN be the SAME. Of course this needs to be thoroughly documented in the medical record.
--Michael G. Warshaw, DPM, CPC, DABMSP
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