3.0 POLICY
When a surgical procedure is
performed at the time of an office visit, both the office visit
and the surgical procedure are covered when modifier 25 is used
as the basis for this situation (indicates that the patient’s condition
required a significant, separately identifiable Evaluation and Management (E/M)
service above and beyond the usual preoperative and postoperative
care associated with the procedure that was performed). If the modifier
is not used, the charge for the office visit is to be denied.