The E/M service is separate from the procedure performed, is not a part of the procedure, and is clearly documented in the medical record.
An initial hospital visit, initial inpatient consult and/or hospital discharge service is billed for the same date as inpatient dialysis providing the service is unrelated or cannot be rendered during the dialysis session.
Preoperative critical care codes are billed within a global surgical period.
During a preventive care visit a significantly, separately identifiable acute care E/M service is also provided. In this instance, modifier 25 should be appended to the acute E/M service code, not the preventive service code.
During a routine foot care visit, a significantly, separately identifiable service is medically necessary.
We recognize the use of Modifier 25 for these code ranges:
Health Care Reform legislation under the Protection and Affordable Care Act (PPACA) outlines mandated preventive services and codes for which modifier 33 is required. Any copayments, coinsurances or deductibles called for under the member’s benefit plan are not applicable for these services.
If the preventive care is provided during an office visit please be aware that a copayment for the visit may apply if:
The preventive care is not the primary purpose of the office visit
The preventive service is billed with other services that require copayment.
It is important to verify benefits and eligibility when delivering any of the preventive services included in the mandate. Please verify benefits and eligibility prior to rendering services.