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Wiki Billing during post op w/ modifier 24

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ValerieR

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Local Chapter Officer
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I had a doc ask me yesterday about this scenario--

Pt has glaucoma and is taking meds to control it. Pt needs cataract surgery so we stop that med as it can increase the chances of complications after cataract surgery. Then after surgery during the 90 day global period everything looks fine so we start up the medication again. At that visit the docs want to charge an office call with the modifier 24 as it's a different diagnosis-glaucoma. I said the starting and stopping of the med was related to the cataract surgery and during the global period so I thought we would not be able to charge an office visit.

As the doc's disagree, I wanted further insight from other coders.
Thanks in advance for your opinion.
 
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I am really tempted to side with your doctor on this one. Depending on how it was documented, I think this could very easily qualify to billed with a 24.

If the patient was there for a follow-up on the surgery and they decided she was stable and put her back on the glaucoma meds then that would be included in the surgery.

On the other hand if the patient came in just for the glaucoma I think that could stand alone and outside of the global period.

They are two completely separate issues, the problem is they are in the same organ. If this was a case of a family practice doctor that did an I&D and 2 days later saw the patient for an URI, there would be no question that this was not part of the global period.

I think it all comes down to documentation and intent on this one.

Laura, CPC
 
We had called them back for the re ck post op cat and decided at that visit that the pt was stable enough to restart the glaucoma med with risk of complications
 
I say it is billable. Modifier -24 can be used to indicate the service is unrelated to the surgery or that the visit is for disease management.

When leveling out the service, I would not "count" anything related to the post-op care rather just the documentation related to the patient's glaucoma.

Lisi, CPC
 
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