AR Management Group welcomes all provider specialties. We are not limited to any specialty and are experienced in the following type of providers:

Modifier 24 is to be used to report an unrelated E&M service during the global period of a previous procedure, including services by other "same-specialty physicians". This means that a surgeon covering postoperative patients for his or her partner does not bill for services provided. Physicians in the same group practice and in the same specialty must bill and be paid as though they were a single physician.

For CMS, all medical and surgical post-surgery complications are included in the global payment and cannot be billed separately unless a return to the operating room is required. Treatment of wound infections and other complications cannot be reported. CPT defines the surgical package as "typical" postoperative care. Medicare has classified major and minor surgeries and has determined what services are inclusive and not inclusive with the global package.

Medicare has also determined the preoperative and postoperative days allowed for each type of surgery. The preoperative period included in the global fee for major surgery is one day, with 90 days for the postoperative period. The preoperative period for minor surgery is the day of the procedure, with the postoperative period of 0 or 10 days, depending on the procedure. For endoscopic procedures, except for those requiring an incision, there is no postoperative period. All global period days can be accessed on the CMS website for review.

Correct use of modifiers makes claims processing easy and providers receive the due reimbursement without any hassle. On the other hand, incorrect use of modifiers will result in payment denials and other complications.

The general guidelines on reporting modifier 25 with CMT codes are as follows:

• CMT codes include a pre-manipulation patient evaluation.
• Additional evaluation and management (E/M) services may be reported separately using modifier 25, if the patient's condition requires a separate E/M service, above and beyond the usual pre-service and post-service. So if manipulation and E/M codes are billed for the same visit, it is necessary to attach modifier 25 modifier to the E/M code.
• As the E/M service may be caused or prompted by the same symptoms or condition for which the CMT service was provided, different diagnoses are not required for the reporting of the CMT and E/M service on the same date.

The bottom line is modifier 25 should be used only when DCs perform an assessment above and beyond the adjustment.

The National Correct Coding Initiative (NCCI) edit program developed by the Centers for Medicare and Medicaid Services (CMS) is used by carriers and third party administrators in an effort to prevent improper payment when certain codes are submitted together. Modifier 59 and some other modifiers are exceptions to the NCCI PTP (procedure-to-procedure) edits.

Under certain circumstances, the physician may need to indicate that a procedure or service was distinct or independent from other non-E/M services performed on the same day. Modifier 59 is used to identify procedures and services, other than E/M services, that are not normally reported together but are appropriate under the circumstances.

CMS instructs that documentation should support a different session, different procedure or surgery, different site or organ system, separate incision or excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. Modifier 59 allows the claim to pass Medicare bundling edits, which would lead to additional reimbursement for the physician.