24 - JF Part A

Unrelated Evaluation and Management (E/M) service performed by the same physician during the postoperative period

Correct Use

• Can be used to indicate that an E/M service or eye exam, which falls within global period of a major or minor surgery and is performed by a surgeon, is unrelated to surgery
• Can only be submitted with E/M and eye exam codes
• When documenting treatment of infection of wound, consider this part of post-operative care
• Supporting documentation of unrelated ICD-9 or ICD-10 code and/or additional documentation may be requested to support that E/M service is unrelated to surgery  

• If ICD-9 or ICD-10 code for E/M service clearly supports visit is unrelated to surgery, there is no need to submit additional documentation

Incorrect Use

• Not appropriate when E/M is for surgical complication or injection
• Not appropriate when patient is admitted to a skilled nursing facility for a condition that is related to surgery
• Not appropriate when E/M is not clearly shown to be unrelated to surgery in medical record documentation
• Not appropriate outside of post-op period of a procedure or on same day as procedure

Resource

• CMS Internet Only Manual (IOM), Publication 100-04, Medicare Claims Processing Manual, Chapter 12