1. Francisco Moreno
   Posted 4 months ago #
   

   I have numerous denials regarding consultations with decision for surgery same day, or next day. Example:
   99222 with25 modifier or 57modifier, and procedure 42961 with 78 modifier. This particular patient had a tonsilectomy in another town, and our dr. was consulted to the ER for post-op bleeding, and immediately took pt. to surgery. We do a lot of hospital consults, many resulting in same or next day surgery. I'm still getting denials after appeals. Is there anything that can be done? Or do we always do free consults???

2. SuperCoder
   Posted 4 months ago #
   

   You are using modifier 78 with 42961, so this is a procedure being performed as a "Return to Op room for a related procedure within Postop Global period".
   In such a case if you are billing an E/M, you should attach modifier 24 with the E/M as the E/M is being performed within the Postop Global period.
   From Reimbursement point of view:
   Whenever you bill a claim using any of the modifier from 22,58,78,79 you should always file with medical records.

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