Annette Posted Thu 11th of July, 2019 15:24:00 PM
Provider billed 99214, 20610, J1720. The Medicare patient was in pain so they came back in 8 days instead of 10 for a follow up and to go over lab work. We billed 99214 and it was denied for Pre/post-operative care payment is included in the allowance for the surgery/procedure. Is there a modifier we can use to get that paid? Thanks!
SuperCoder Answered Fri 12th of July, 2019 05:18:34 AM
Thanks for your question.
Follow-up visits during the post-operative period of the surgery that are related to recovery from the surgery and the post-surgical pain management by the surgeon are included in the global surgery payment. So this service may not be paid separately.
Please feel free to write if you have any question.
Annette Posted Tue 16th of July, 2019 09:35:18 AM
Hi - even if it was an "emergency"? The patient couldn't wait the 10 days.
SuperCoder Answered Wed 17th of July, 2019 03:07:04 AM
It does not make any difference even if the patient has returend to the ER for follow-up or complication of the original surgery. The E/M service may be reported with modifier 24 only if it is unrelated to the surgery.
Moreover, if the physician must return to the OR to treat a postop complication, both Medicare and private payers will pay at a reduced rate when you append the appropriate modifier to the surgical CPT® code describing the surgeon’s treatment of the postsurgical complication. If the surgeon returns to the operating room to surgically correct a post-operative complication during the global period of a previous surgery, the correct modifier is 78 (Unplanned return to the operating/procedure room by the same physician or other qualified healthcare professional following initial procedure for a related procedure during the postoperative period).
Hope this helps.