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Mary Posted Mon 26th of March, 2012 20:56:24 PM

My physician saw a pt on 2/1/12 on consult in the hospital. On 2/2/12 one follow up visit. on 2/3/12 an upper endoscopy with foreign body removal was done with gstric retention of nearly 700 mL of fluid and some barium. At 5 pm on the same day she was taken back to the endoscopy department were an upper endoscopy with balloon dilatation was done with successful dilatation of anastomotic stenosis of the efferent limb of the Bilroth II. Can I bill for both of these? Then can I charge follow up visits with the modifier 24 for post procedures?

SuperCoder Answered Tue 27th of March, 2012 03:51:46 AM

Yes. You can bill both of these. You should append modifier -78 to the second procedure done on 5 pm. You should not bill EM-24 for 2/2/12 because this followup is done before the procedure. If it would have after 2/3/12 and not related to the original procedure, you would have billed E/M with -24.

Maarit Answered Tue 17th of April, 2012 19:26:50 PM

Hi Birendra, can you please explain why the subsequent hospital visit should not be billed? What if the decision to do EGD was made that day, so you would not regard it as pre-op. Surgeons may follow a PT for days before the decision for surgery is made, and I believe those visits should be paid for.

SuperCoder Answered Wed 18th of April, 2012 06:55:22 AM

Hi Maarit,

I think you understood it in a different way. I told you that you can bill both visits without appending modifier -24. You should not bill EM with appending -24 modifier means you should only bill office visit without appending -24.

02/01/12-Hospital consult billable
02/02/12-Office visit billable wihtout modifier -24
02/03/12-billable procedure code
02/03/12-5 PM-billable procedure code with modifier -78

You are billing procedure code for DOS 2/3/12 and on the same day 5pm, for post procedure, you are billing dilatation code with modifier -78. Therefore, you should not bill any E/M for subsequent procedure done on 5pm. Guideline says minor procedure with related preoperative and postoperative relative values on the day of the procedure only included in the fee schedule payment amount; evaluation and management services on the day of the procedure generally not payable.

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