If a provider is billing an office visit within the global period, do they have to append modifier 24? I would think that modifier 24 is required, however I am receiving "push back" from others that the diagnoses codes reported should alert the coder that it is unrelated.
Any help would be appreciated!
Thank you in advance,
Lori Dunbar, CPC
Hi Lori.
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You are correct. To ensure payment for E/M services your physician performs within the global period of a surgical procedure, you must know the ins and outs of modifier 24 (Unrelated evaluation and management service by the same physician during a postoperative period).
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You should only append modifier 24 to an appropriate E/M code when an E/M service occurs during a postoperative global period for reasons unrelated to the original procedure. Modifier 24 tells the payer that the surgeon is seeing the patient for a new problem.
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Relating to the dx coding: While a different ICD-9 diagnostic code might indicate that the E/M service performed in a global period was unrelated to the surgery, you do not have to have different diagnoses to append modifier 24 and to receive payment for those services.
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It is not actually even necessary that the two services have a different diagnosis but it should be clear that the service is performed to discuss results, prognosis and treatment options and that any work done related to the surgery (change bandages, check wound, etc.) is not used to support the level of service billed.
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I hope this helps.
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Thanks,
Leesa
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Leesa A. Israel, BA, CPC, CUC, CMBS
Executive Editor, The Coding Institute
Manager, TCI Consulting & Revenue Cycle Solutions
Home office: (866) 458-2973
Email: leesai@codinginstitute.com
http://www.codinginstitute.com
