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Issue Number - Name
0033 - E&M Codes billed within a Procedure Code with a 10 Day Global Period (other minor 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

E&M Services that are incorrectly billed within the codes that have a Global Days designation of "10" 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 "010" include only E & M services on the day of the procedure and up to 10 post-operative days.  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 "010"

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, (Addendum)