EM Coding Alert

Modifier will make unrelated E/Ms during surgical globals fly.

Most E/M services for patients during the global period of a recent surgery are of the postoperative kind. If your provider performs an E/M for anything related to the surgery during the global period, it is part of the postop package, and therefore not separately codeable.

Problem: How do you code for an E/M that’s unrelated to the patient’s recent surgery? Things will be a lot easier if you’re familiar with modifier 24 (Unrelated evaluation and management service by the same physician or other qualified health care professional during a postoperative period). When used in the proper situations, modifier 24 could be a boon to your bottom line.

Avoid E/M denials during the postop period with this expert modifier 24 advice, and keep it close in case the same provider performs an unrelated E/M service on a patient during the global period.

Same Provider Must Provide Both Services for E/M-24

Use modifier 24 if the physician who performed a surgical procedure “sees the patient during the postoperative period for an [E/M] service unrelated to the surgery,” says Suzan (Berman) Hauptman, MPM, CPC, CEMC, CEDC, medical coding director at Acusis in Pittsburgh, Pa.

If the patient reports for any unrelated E/M that occurs during a postop global period — including hospital visits, office visits, etc. — you must append modifier 24, confirms Celia Forde, CPC, CPCH, coding specialist for Florida’s Centra Care, which has offices in the Orlando area.

Example: The physician performs a complicated incision and drainage (I&D) to treat a carbuncle on the patient’s left thigh on Monday (10061, Incision and drainage of abscess [e.g., carbuncle, suppurative hidradenitis, cutaneous or subcutaneous abscess, cyst, furuncle, or paronychia]; complicated or multiple). On Wednesday, the patient returns to the office complaining of pain in her right shoulder after playing tennis.

The physician who performed the earlier I&D examines the new shoulder injury and sends the patient home with instructions on treatment. Notes indicate a problem-focused history, an expanded problem-focused exam, and low-complexity medical decision making.

For the Wednesday E/M service, report 99213 (Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: an expanded problem focused history; an expanded problem focused examination; medical decision making of low complexity) with modifier 24 appended to show that the E/M was unrelated to the patient’s recent I&D surgery.

Explanation: Four facts make this E/M service modifier 24 eligible:

1. The same provider who performed the I&D performed the shoulder injury E/M.
2. The global period for 10061 is 10 days.
3. The patient reported for treatment of her shoulder injury during the global period for 10061 (two days later).
4. The shoulder injury E/M was completely unrelated to the I&D of the thigh.