DRG Coding Advisor-Changes to Modifier -25 Rule

The 2000 Medicare physician fee schedule makes these changes in the use of the -25 modifier:

• It includes procedures with a global period indicator of "XXX'' in the application of the global surgery payment policy relating to the use of modifier -25.

• The Health Care Financing Administration does not require the routine use of modifier -25 with all procedures having a global indicator of "XXX." Instead, HCFA will later identify specific codes the modifier is to be used with when an evaluation and management (E/M) service is furnished.

• Before paying a -25 related claim to a low level E/M, HCFA wants to see documentation justifying a "significant and separately identifiable" service or procedure.

• Specific procedure codes for which the use of modifier -25 is required when a significant separately identifiable E/M service is furnished and reported by the same physician or nonphysician practitioner will be published as edits in the Correct Coding Initiative no earlier than Oct. 1.