My biller said she heard at one of your seminars that we did not need to append a −25 modifier to an E/M charge in conjunction with 51798. This does not seem to be correct. I specifically remember being told many years ago that we had to attach a −25 modifier to any E/M service when charging in conjunction with any 50000 code.
We’re glad you asked that question. We can see that there is still lot confusion on this issue, as we audit hundreds of urology charts each year.
Many years ago, what you were told was correct. All of the 5XXXX codes were either 0-, 10-, or 90-day globals. Charging an E/M service with any CPT code from the Surgery section would require the appropriate modifier, and –25 is the most appropriate in the majority of cases.
However, as time changes, so do Medicare rules. Your biller is correct at this time. When billing Medicare, you do not need a –25 modifier attached to the E/M when billing with 51798 (Measurement of post-voiding residual urine and/or bladder capacity by ultrasound, non-imaging).
51798 is listed as “Global:XXX” and by definition, the global concept does not apply to the code. Uroflow (51736 and 51741) and electromyography (51784 and 51785) are also classified as XXX procedures. For Medicare patients, do not add the −25 modifier to an E/M code when billing in conjunction with an XXX global procedure. In addition to the above, 51741, all laboratory services (including urinalyses), and imaging procedures are listed as XXX global services.
The exception to that rule are the few XXX procedures/services that include E/M services in the bundled service list under the NCCI edits.
An example of an XXX global procedure that requires a modifier for an E/M code reported on the same date is 96402 (Chemotherapy administration, subcutaneous or intramuscular; hormonal anti-neoplastic).
The exception to that rule are the few XXX procedures/services that include E/M services in the bundled service list under the NCCI edits.
An example of an XXX global procedure that requires a modifier for an E/M code reported on the same date is 96402 (Chemotherapy administration, subcutaneous or intramuscular; hormonal anti-neoplastic).
Also see – NP, PA incident-to billing: What is (and isn’t) allowed
If you check the bundling matrix in AUAcodingtoday.com, you will be able to see if a modifier is required for E/M code by entering all codes to be charged that date and clicking “analyze codes.” The bundling matrix will indicate whether an E/M code needs a modifier for either an NCCI bundle or a global period bundle.
