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Issue Number - Name
0034 - E&M Codes billed within a Procedure Code with a 90 Day Global Period (major surgeries)
Review Type
Automated
Claim Type
Physician/Non-Physician Practitioner
Region and State
RACS 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 "90" 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 "090" include only E & M services on the day before the procedure, the day of the procedure and up to 90 days 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 090.

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)