E&M Service within global period of SCS Trial

[mgrimaldi]

After our physician performs an SCS Trial, he will bring the patient in within 1 week to discuss the success of the trial and/or plan for the permanent implant. At this point, it is still within the 10 day global period. Would it be appropriate to bill an E&M service with modifier 58 applied?

Any feedback would be greatly appreciated.
Thanks

[mcnaryk]

Originally Posted by mgrimaldi

After our physician performs an SCS Trial, he will bring the patient in within 1 week to discuss the success of the trial and/or plan for the permanent implant. At this point, it is still within the 10 day global period. Would it be appropriate to bill an E&M service with modifier 58 applied?

Any feedback would be greatly appreciated.
Thanks

No, if your physician wants to assess the patient's condition after the trial, he should schedule that visit after the 10 days are up in order to charge. Otherwise it's part of the global package for inserting the SCS in the first place.

[dwaldman]

mgrimaldi,
I saw your post and noticed that you mentioned placing the 58 modifier with an E/M service. As seen below, modifier 58 would be for reporting a procedure code (non E/M) for a staged, planned, more extensive or related procedure during the global period.

Whereas, modifier 24 would be used on an E/M service if the medical record supports the patient had a separate condition that was unrelated to procedure or the recovery from that procedure.

In what you describe, the visit would be reported internally as CPT 99024 as a post op visit as mcnaryk indicated.

You want to be able to provide the facts regarding the ten day post operative period to provider while maintaining the provider should make the determination when it would be most appropriate for the patient to return to discuss the prior procedure and additional treatment options.


http://wpsmedicare.com/j5macpartb/re...odifiers.shtml

24 Unrelated Evaluation and Management Service by the Same Physician During a Postoperative Period Modifier 24 indicates the physician performed an unrelated E/M service during the post-operative period
Bill modifier 24 with the appropriate level of E/M service
Documentation supports E/M visits submitted with modifier 24 are unrelated to the post operative care of the procedure. ICD-9 codes that clearly indicate the reason for the encounter was unrelated to surgical post operative care may provide sufficient documentation.
If sufficiently documented, use Modifier 24 when furnishing an E/M service that is exclusively for treatment of the underlying condition and not for post-operative care.
Physicians who are managing immunosuppressant therapy during the post-operative period of a transplant may bill for the E/M service with modifier 24. ICD-9-CM V07.2 may be appropriate to document the need for this service.
Physicians who are managing chemotherapy during the post-operative period of a procedure may bill for the E/M service with modifier 24. ICD-9-CM V58.1 may be appropriate to document the need for this service.
Do not use modifier 24 Unrelated E/M service the same day as a procedure or to document treatment of a wound infection.

__________________________________________________ ____________________

58 Staged or Related Procedure or Service by the Same Physician During the Postoperative Period Modifier 58 indicates the physician, or member of the same group, planned the performance of a procedure or service during the postoperative period prospectively or at the time of the original procedure.
Bill modifier 58 with the subsequent performed procedure
Use during the post-operative period starting the day after the initial procedure.
Not appropriate for services performed on a single date of service.
Not appropriate when the MPFSDB indicates XXX global period.
Not appropriate with assistant at surgery
Not appropriate for Ambulatory Surgical Center’s Facility fees