Use of evaluation and management modifier 25 for billing a minor procedure on the same day

Physicians and non-physician practitioners (NPP) who bill for minor procedures in the office frequently wish to bill for an evaluation and management (E&M) visit the same day as the minor procedure. The only circumstances that allow this are:

  • The patient must be seen for a condition unrelated to the diagnosis for the procedure.
  • There must be significant care provided for the condition beyond the minor procedure (with expanded plan of care).
  • Medicare states that even for a new patient visit, the minor procedure includes all related E&M services for the procedure itself.

Endoscopy services, debridement, nail care and joint injections are considered minor procedures and must follow the above rules.

Please refer to the Medicare Global Surgery ICN907166 FAQ for more information.