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Modifer

Chery Posted Fri 12th of October, 2012 18:02:05 PM

The doctor the to hospital and lasered an infant. They went back again a week later to do an exam. Is there a modifer I can use so the doctor will be reimbursed the exam given during post op period.

SuperCoder Answered Fri 12th of October, 2012 21:48:52 PM

The following Modifers could be used as per your requirements.

58-Staged or Related Procedure or Service by the Same Physician During the Postoperative Period

Modifier 58 indicates the physician, or member of the same group, planned the performance of a procedure or service during the postoperative period prospectively or at the time of the original procedure.
Bill modifier 58 with the subsequent performed procedure
Use during the post-operative period starting the day after the initial procedure.
Not appropriate for services performed on a single date of service.
Not appropriate when the MPFSDB indicates XXX global period.
Not appropriate with assistant at surgery
Not appropriate for Ambulatory Surgical Center's Facility fees

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78-Return To The Operating Room For A Related Procedure During The Post-Operative Period

Used to indicate the performance of a procedure during the postoperative period or on the same day as the original procedure to treat complications, which required return to the operating room
Bill modifier 78 with the CPT code describing the procedure(s) performed during the return trip.
Only use the procedure code for the original procedure if the identical procedure is repeated.
When the procedure code used to describe a service for treatment of complications is the same as the procedure code used in the original procedure, modifier 78 is still the correct modifier to use.
Modifier 78 reimbursement is intra-operative percentage only.
Use Modifier 78 to document treatment of complications only.
Use Modifier 78 to indicate services furnished in an operating room (OR). OR definition, for this purpose, is a place of service specifically equipped and staffed for the sole purpose of performing procedures. The term includes a cardiac catheterization suite, laser suite, or endoscopy suite. It does not include a patient's room, minor treatment room, recovery room, or intensive care unit.
Does not apply to assistant at surgery services
Does not apply to Ambulatory Surgical Centers facility fees

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79-Unrelated Procedure or Service by the Same Physician During the Postoperative Period

Modifier 79 indicates the performance of a procedure or service during a post-operative period was unrelated to the post-operative care of the original procedure.
Bill Modifier 79 with the procedure performed.
Do not bill when the MPFSDB indicating XXX in the post-operative field.
Use modifier 79 on services during the post-operative period starting the day after the procedure.
Does not apply to assistant at surgery services
Does not apply to Ambulatory Surgical Center's facility fees

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24-Unrelated Evaluation and Management Service by the Same Physician During a Postoperative Period

Modifier 24 indicates the physician performed an unrelated E/M service during the post-operative period
Bill modifier 24 with the appropriate level of E/M service
Documentation supports E/M visits submitted with modifier 24 are unrelated to the post-operative care of the procedure. ICD-9 codes that clearly indicate the reason for the encounter was unrelated to surgical postoperative care may provide sufficient documentation.
If sufficiently documented, use Modifier 24 when furnishing an E/M service that is exclusively for treatment of the underlying condition and not for post-operative care.
Physicians who are managing immunosuppressant therapy during the post-operative period of a transplant may bill for the E/M service with modifier 24. ICD-9-CM V07.2 may be appropriate to document the need for this service.
Physicians who are managing chemotherapy during the post-operative period of a procedure may bill for the E/M service with modifier 24. ICD-9-CM V58.1 may be appropriate to document the need for this service.
Do not use modifier 24 Unrelated E/M service the same day as a procedure or to document treatment of a wound infection.

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