Documenting and coding for E/M services is one of the biggest challenges in cardiology coding. Not only is there the fear of under coding and under documentation that leads to loss of revenue, but also end up in costly audits that are increasing by the day.In cardiology coding, modifier 25 is used to report Evaluation and Management service for one day when the same physician has provided another service.One should not use modifier 25 when:Billing is being done for services that were performed during the postoperative period and it is related to the surgery done previously.
During office visit only E/m service is done.
When a major procedure is done on a particular day.
On the same day, minimal procedure is done and its level can be represented as significant and separately identifiable.
Patient has come for scheduled procedure.When using modifier 25, one should take the following into consideration:Payment will be affected the way modifiers are used to report third-party payers of circumstances.
E/M CPT code must always be linked to the modifier.
Two different diagnosis codes are not required.
Documentation of E/M and procedure is essential.According to NCCI correct coding guidelines, modifier 25 can be used for E/M services with small surgical procedures or ones which are not covered by global surgery rules. Since these include pre, intra and post-procedure work that is inbuilt in the procedure, E/M service cannot be reported for this by the provider. Additionally, Medicare Global Surgery policies does not let a separate E/M service get reported for the work related with the choice to perform a small surgical procedure even if the patient is new or established with the choice to perform the surgery on that particular day or the next.
When a claim is submitted to the provider with modifier 25, one is not only asking the provider for pay but also for the visit and the procedure done. You might also get paid for both. Often such claims are reviewed closely. This led to stop in payment because of incorrect billing and coding, inadequate documentation to support procedures, and not having appropriate reasons to state medical necessity of billed codes on the same day by the physician.So, in conclusion it can be summed up that although coding and billing for E/M related services is tricky and confusing that can lead to errors and loss in pay, one can overcome such situations if there is a proper understanding of cardiology codes 2013 and correct use of E/M codes.For inpatient, outpatient and ambulatory surgery centers hospital outpatient modifier 25 can be used. Also, for critical care and emergency department visits, one can use modifier 25 to report situations.