Podiatry Coding & Billing Alert

Question: I’m new to coding, and I’m still trying to understand some CPT^® modifiers. Can we append modifier 24 if the E/M service is related to the original surgery like a complication or infection?

California Subscriber

Answer: No. You cannot bill separately for evaluation and management (E/M) related services relating to the original surgery during the global period. A surgical complication or infection is considered part of the surgery package. When you append modifier 24 (modifier 24 (Unrelated evaluation and management service by the same physician during a postoperative period) you are telling the payer that the surgeon is seeing the patient for a problem unrelated to surgery. Therefore, the medical record must support that the E/M visit was unrelated to the postoperative care, and the diagnosis should clearly indicate the reason for the unrelated postoperative encounter.

Some third-party payers will consider services provided for some complications. Touch base with them before submitting the claim.