Billing Modifier 24 for respiratory failure or infection during a postop period?

adri3421

Networker
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I am trying to figure out if it is appropriate for a surgeon to bill postoperative hospital subsequnt visits in the critical care unit using modifier 24 if the patient experiences respiratory failure or sepsis after a surgery on a medicare patient. These visits do not qualify for the critical care codes 99291/99292 so I would have to bill subsequent 99231-99233 codes w/-24 modifier.

Would these conditions be "related or complications" to the surgery or are these "new conditions" not typically included in the global package?

My providers argue these conditions are not part of "typical" recovery from surgery and should not be included in the surgical global package.

Any thoughts?
 

Lujanwj

Guru
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The simple answer is to show the guidelines in Appendix A to the doctor. If dr can document and justify "unrelated to the original procedure" than bill. It doesn't matter that it not a "typical" recovery, he still has to show unrelated. With that said, if the issue is of a different organ system, you can bill it (that's kind of a gray area).

Good luck!
 
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