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Surgical modifier help

Robert Posted Fri 11th of November, 2011 20:59:57 PM

How should these two line items be billed? I was told to put a modifier 24 because the patient had a similar procedure done within the 90 day global period. So to distinguish the two as separate I needed to put a 24. But, today I received a denial from medicare for "missing or improper modifier". Please advise.

How I billed:
99214 24 -This line item was paid
28043 24 -This line item was denied

Catherine Answered Sat 12th of November, 2011 12:33:17 PM

The 24 modifier should be appended to the e/m service only. It cannot be used with the surgical code.

Catherine Answered Sat 12th of November, 2011 22:55:07 PM

Actually. The mod should be 25.

SuperCoder Answered Sun 13th of November, 2011 18:41:49 PM

99214 with modifier 24 was appropriate as you wanted to justify that you have provided an E/M service unrelated to earlier visit, although within the global period of previous surgery. So, it got paid.

28043 was not paid because modifier 24 is not applicable to this CPT, at the same time, since a similar procedure being performed earlier, so this time you can use modifier either 58 or 78.

If this procedure was planned in the earlier surgery then you would use code 28043-58, if not planned, then modifier 78.
Again, when you are using modifier 58 or 78, you have to submit the detailed medical records while refiling.

Robert Posted Mon 21st of November, 2011 21:58:33 PM

Thank you for your response Sanjit, much appreciated.

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