Know When to Bill E/M Services With Modifier -24
Published on Sun Oct 01, 2000
When a neurosurgeon performs an unrelated evaluation and management (E/M) service on a patient during a postoperative global period, the visit is billable if modifier -24 (unrelated evaluation and management service by the same physician during a postoperative period) is appended to the appropriate E/M code and you provide the correct documentation. Many neurosurgeons bill modifier -24 when it is not needed, and others dont know when to use it. Make sure your practice receives rightful reimbursement by knowing when to use modifier -24.
Unfortunately, says Cynthia Thompson, CPC, senior coding consultant with Gates, Moore & Co., a physician-practice management consulting firm in Atlanta, many neurosurgeons are unaware of this modifier and bill for the E/M without it. Usually, the carrier will deny the claim because the modifier is not there.
Other neurosurgeons believe that any office visit after surgery is part of the procedures global period, so they dont ever bill for it. For example, a patient undergoes surgery for excision of a parietal tumor (191.3) and during recovery develops an unrelated aneurysm (441.1). The surgeon sees the patient during rounds and provides E/M services related to the aneurysm but assumes the service isnt billable. In reality, most of the time spent during the E/M service was spent dealing with the aneurysm, meaning an office visit should have been billed. Neurosurgeons should remember, however, that the portion of the examination actually related to the post-op cannot be included among the factors in determining the correct level of E/M.
A parietal tumor and an occipital tumor (239.6) should be considered unrelated. They are separate diagnoses and separate conditions. But under such circumstances, denials may be issued because carriers may be confused when seeing multiple services billed for tumor treatment, and an appeal may be necessary to gain optimal reimbursement.
New Diagnosis Is Necessary
Although some neurosurgeons underuse modifier -24, others use it inappropriately, attaching it to office visits when the patient has minor complications from the original procedure, such as a post-op wound infection. Some neurosurgeons may append modifier -24 just to get paid for any E/M service, including routine rounds during the global period.
To bill appropriately for an E/M with modifier -24 attached, however, the diagnosis must meet the carriers definition of what an unrelated service to the original surgery actually is. For example, Medicare carriers will not pay for E/M services relating to post-op complications, but many commercial payers will because their definition of unrelated is more in line with that of CPT. The manual states that follow-up care for therapeutic surgical procedures includes only that care which is usually a part of the surgical service. Complications, exacerbations, recurrence or the presence of other diseases or injuries [...]
