Medical Posted Wed 26th of November, 2014 18:06:26 PM
On 10-9-14 the pt was seen for an initial exam CPT 99204 dx 6692-.9
On 10-24-14 we billed 12031 and 11402 dx 238.2
On 10-28-14 the patient returned we billed 99213 dx 709.2 692.9.
On 11-6-14 the patient returned we billed 99213 dx 692.9
On 11-7-14 the pt returned we believe the patient removed her stitches. Wound repair was done we billed 99212 DX 692.9
The insurance have denied date of service 10-28-14 because service was included in a surgical procedure. Should we have billed the office visits using a modifier. can you please advise?
SuperCoder Answered Wed 26th of November, 2014 19:42:11 PM
Thanks for your question. In this instance you should have appended a modifier to the E/M code for date of service 10/28/14. 11402; Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or legs; excised diameter 1.1 to 2.0 cm and 12031; Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities (excluding hands and feet); 2.5 cm or less both have 10 day global periods. This means if your patient returns within the 10 day global period, you should append modifier 24 if the visit is unrelated to the surgery.
When you report modifier 24, the E/M service must meet the following criteria:
The E/M service occurs during the postoperative period of another procedure.
The current E/M service is unrelated to the previous procedure.
The same physician (or tax ID) who performed the previous procedure provides the E/M.
If the E/M service is related to the surgery/procedure or if it is due to a complication from the surgery you would not bill separately. Please see the attached link for additional information related to global services. Hope this helps.