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Modifier 24 to disucss breast reconstruction

Stephanie Posted Mon 09th of December, 2019 19:54:20 PM
Hi, my provider performed bilateral breast reconstruction a few weeks ago and placed expanders in each breast. The patient is in the office now to discuss the completion of the breast reconstruction. He spent 45 minutes going over his plan and how he will reconstruct each breast and place the final implants. Would his work for the preop visit be billable under an E&M code w/ a modifier 24? The patient is still in a global.
SuperCoder Answered Tue 10th of December, 2019 01:27:59 AM

Hi Stephanie,

 

Thank you for your Question.

 

If the patient is in global period of previous surgery and the E&M service performed during the post-operative period that is related to previous surgery would not be separately billable. If the E/M is unrelated to previous surgery then modifier 24 would be appropriate to append with E&M CPT code.

Modifiers “-24” (Unrelated E/M service by the same physician during a post-operative period) is used when a separately identifiable E/M service falls within the post-operative period of another unrelated procedure. The physician may need to indicate that an E/M service was furnished during the post-operative period of an unrelated procedure. An E/M service billed with modifier “-24” must be accompanied by documentation that supports that the service is not related to the post-operative care of the procedure.

Note: You cannot bill separately for E/M-related services relating to the original surgery during the global period. The global surgical package includes routine postoperative care during the global period. Please find undermentioned link for more information. 

 https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/GloballSurgery-ICN907166.pdf

 

Hope that Helps!

 

 

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