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Evaluation and Management Services
- Evaluation and Management Services
- General Principles of Medical Record Documentation
- What Should Be Provided if Medical Records Are Requested for Review?
- Hospital Inpatient or Observation Evaluation and Management Add-On Code G0545 for Infectious Diseases
- Office/Outpatient Evaluation and Management Visit Complexity Add-on Code G2211
- Related Resources
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FAQs
- Admission and Discharge Services
- Advanced Care Planning
- Behavioral/Mental Health Services
- Chronic Care Management
- Complex and Chronic Care - HCPCS Code G2211
- Consultations
- Critical Care Services
- Documentation
- Emergency Department
- Examination
- Fee-For-Time Compensation Arrangements
- General E/M Information
- Global Period Services
- History
- IPPE and AWV Services
- Medical Decision Making
- New vs. Established Patients
- Nonphysician Practitioner Services
- Observation Services
- Preoperative Clearance
- Prolonged Services
- Provider Specialty
- Scribes
- Separately Identifiable Service
- Skilled Nursing Facility Services
- Smoking Cessation
- Split/Shared and Incident To Services
- Teaching Environment E/M Services
- Telehealth Services
- Time-Based Services
- Transitional Care Management
- Urgent Care
- Related Articles
Global Period Services
- How do global period rules apply to critical care services
Answer: Global surgery rules apply to the primary surgeon who performed and billed the surgical service that established the global period. When the primary surgeon performs a critical care service within the global period for a problem unrelated to the surgery, the surgeon bills the critical care service with modifiers 24 and FT. (Modifier FT is effective 1/1/2022 and required 3/1/2022).
- If a surgery/procedure is cancelled pre- or post anesthesia induction, can the surgeon bill an E/M based on the preoperative history, examination and plan that is documented, detailing why the surgery was cancelled?
Answer: When a surgical procedure is cancelled in this situation, the surgeon’s preoperative E/M service is no longer bundled into the surgical package and may be separately billed. If the surgery were to be performed later that same day, the E/M would again be bundled into the package.
- What constitutes “start of procedure” per CMS?
Answer: CMS considers surgical incision (or start of procedure if no incision required) as the start time for the procedure.
- What scenario/situation is appropriate for use of modifiers 24 and 25 on the same claim for an E/M service, e.g., 99212 24/25?
Answer: Modifier 24 describes an E/M service during a global period, unrelated to the procedure that established the global period, while modifier 25 describes a separately identifiable E/M service when a procedure is performed during the same encounter. The need for both of these modifiers on the same claim during a global period would be unusual; the following scenario is an example of a scenario in which both modifiers could be used:- A patient is seen by the operating surgeon for an office f/u mid-level visit, two weeks after a hemi-colectomy. During the visit, the patient presents with an infected abscess on the right shoulder. The provider addresses this unrelated problem and recommends a course of antibiotics. This service could appropriately be billed as 99213 24, since it is unrelated to the hemi-colectomy.
- If the provider scheduled the patient for a f/u visit for possible I&D of the abscess, and the patient presented with two additional abscesses that required further evaluation, billing for the second visit could include 99213 24/25, along with, along with CPT 23030 for the I&D.
Revised 1/23/2025