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Modifier for evaluating a patient requesting a second opinion during the post-op 90 day global

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cjgehegan

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Edgewater, New Jersey
Which cpt code and modifier is appropriate if a patient recently underwent a surgical procedure by ANOTHER surgeon and is having concerns/seeking a second opinion during the 90 day post-op global period regarding the surgery performed?
 
If it's a surgeon in a different practice, then no modifier is needed.

If it's in the same practice, then I think you'd need to review the documentation and see if a modifier 24 would be supported, and if so, use that. I don't think there are any other options. If it's not supported, then the visit couldn't be billed.
 
Thank you for your quick response. Would you happen to know the best option if the group consists of 20 separate practice locations under one company and the two doctors do not practice at the same location?
 
cjgehegan said:
Thank you for your quick response. Would you happen to know the best option if the group consists of 20 separate practice locations under one company and the two doctors do not practice at the same location?
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It doesn't change my answer above. If the two providers are of the same specialty and are billing with the same tax ID number, then it's going to be treated by payers as if this was the same provider. So if it's in the global period, then you're going to have to decide if the documentation supports a modifier 24 or if it is postoperative care and not billable. For example, if the new provider is being seen about post-operative care for the recovery and/or complications, then it's inclusive in the surgical package and shouldn't be separately billed, but if the visit is unrelated to the recovery from the procedure, such as for treatment of the underlying condition or an added course of treatment that's not a normal part of the post-operative care, than you may bill the visit with a modifier 24. Those are really the only two options in this situation. Without seeing the documentation of that visit, I can't advise you on which is correct.
 
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