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E&M within Global

Kathy Posted Mon 18th of January, 2016 12:19:27 PM

One of our providers saw a patient within the global of a spine surgery. He saw the patient for 15 min's, but "counseled" the patient for half of that time, going over MRI's and another upcoming spine surgery. AFTER patient left & was getting into his car, he felt a pop in his leg, unrelated to his previous surgery. Our provider called for an ambulance, assessed the patient at the hospital, made a decision for surgery & billed for the hospital E&M & leg surgery. In this situation is there any way the provider can appropriately bill for the office visit? Thanks.

SuperCoder Answered Tue 19th of January, 2016 00:37:15 AM

Ideally, The provider cannot bill E&M visit made in Global Period of any Surgery, if the E&M is related to the Surgery. But as you mentioned that your Provider provided the E&M services for the reason other than or unrelated to his previous surgery. In that case, you can bill the appropriate E&M service CPT code with -24 modifier (Unrelated Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional During a Postoperative Period). Also, if decision was made for major surgery, append modifier -57 (Decision for Surgery).

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