K Posted Mon 15th of July, 2019 13:02:27 PM
I was not able to find any post about post op care so here is my question. I need some help figuring out what we can bill for in the post op care. Most of the surgeries are 90 follow up that we deal with in our billing department. I bill for a group of multi specialty providers with the same TIN.
What or how do you support that the visit is not global and is needed care with reimbursement?
I understand that we should use modifier 24 when it is supported, but do you find using a different DX code that is different from the reason for surgery as the first dx, then in the 2nd slot the surgery dx to help support reimbursement with modifier 24?
What if the wound is compromised open or infected or something like that?
What if the ortho provider refers the pt to a pain provider in the same group for post op for pain control. How do you support the reason for reimbursement? Do you have a letter that documents the request for the pain provider to provide pain care follow up?
I would appreciate any information you can pass along. When ever I have meetings with the providers, I like to have as much information to support the correct guidelines with coding.
Thank you for your time! :)
SuperCoder Answered Tue 16th of July, 2019 04:29:25 AM
Thanks for your question.
Modifier 24 may be append to the unrelated E/M service by the same physician (Physicians in the same group practice who are in the same specialty) during a postoperative period. You cannot bill post-operative care separately within the global period.
If your provider provides E/M service for a different problem, which is unrelated to that of the original surgery, then you may bill that service separately with modifier 24 (Unrelated Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional During a Postoperative Period).
Please feel free to write if you have any question.