Appropriate use of 25 mod?

dvance4210

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I have a patient that had CABG surgery on 12-14-16 by one of our cardiothoracic surgeons and was seen in our office within the post-op period by our other surgeon for thoracic lung surgery (VATS/decortication) due to a trapped lung. Is it appropriate to add the 24 mod to the 2nd surgeons' established patient office visit or is she considered a global visit? Please advise.

D. Vance
 
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thomas7331

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If your two providers are of different specialties, then no modifier should be required here. Modifier 24 is by definition only for services by the 'same provider' (though most payers consider providers of the same specialty in the same group to be the 'same provider'). But if your two providers would be considered the same specialty by the payer, you'll need to review the documentation and see if this is considered an unrelated problem, or a treatment for a complication related to the CABG. If it's unrelated, then a modifier 24 would be appropriate.
 

dvance4210

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They are both cardiothoracic surgeons in my case. The 2nd surgeon who is performing the upcoming VATS/decort is trying to "plead his case" that this is a separate issue, where I feel it is a result of the CABG surgery. I feel that he will see my side after I show him your post.

Thanks for your input

Dorinda
 
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