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Issue Number - Name
0032 - E&M Codes billed within a Procedure Code with a 0 Day Global Period (Endoscopies or some minor surgical procedures)
Review Type
Automated
Claim Type
Professional Services (Physician/Non-Physician Practitioner)
Region and State
RAC 1-4
All States
Date Approved
2017-12-12

Description

This Query identifies E&M Services that are incorrectly billed within the codes that have a Global Days designation of "0" days. Under the Medicare Physician Fee Physician (MPFS) rules, most surgical procedures include pre-operative and post-operative Evaluation & Management services. These E & M services are referred to as 'Global Days'. Procedures with MPFS global days of "000" include only E & M services rendered on the day of surgery. Physicians can indicate that E & M services rendered during the global period are unrelated to the surgical procedure by submitting modifiers 24 (unrelated Evaluation and Management Service By Same Physician During Post-operative Period), 25 (Significant Evaluation and Management Service By Same Physician on Date of Global Procedure) and 57 (Decision For Surgery Made within Global Surgical Period) on the E & M service.

Affected Codes

  • All CPT and HCPCS codes with MPFSDB Global Days values of "000."

Applicable Policy References

  • Social Security Act, Section 1833 (e)
  • CMS Pub. 100-04 Medicare Claims Processing Manual, Chapter 12 
  • CMS Pub. 100-04 Medicare Claims Processing Manual, Chapter 23 (Addendum)