EM New patient E/M with a minor procedure

[Scrappy]

Question: Modifier 25 and a new patient with a minor procedure. NCCI- January 2016 publication - addressed this issue on page I-18- Example 99203 - 11042. There is no global period for 11042. I am having difficultly finding what is separately identifiable to support the mod 25. Thank you.

 

[Jo-Anne Sheehan CPC-I]

You are correct about the 0 day global for 11042. However, you must still add a modifier 25 to the E/M visit because the visit is a significant, separately identifiable E/M linked to the procedure on the same day by a health care provider.
Typically, modifier 25 is linked to minor/non-invasive procedures such as 11042 or a colonoscopy, which is also a 0 day global.
A ten (10) global surgery, minor surgery would also require a modifier 25 on the E/M.
Major surgery requires a modifier 57 for decision for surgery (90 day global rules)