Complication in global period Modifier 24 for E&M


Santa Clara, CA
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If a patient develops post op infection during the global period, say pacemaker infection and returns to the OR, is it correct that we cannot bill the e&m hospital visits with modifier 24 still? I am getting mixed advice.

From reading the medicare guide, it reads to me that only the return procedure can be billed, and that "it does not include a patient's room". Which makes me think we cannot bill the e&m hospital visit with modifier 24 for a complication, is this correct? Some say that we can bill an e&m in an hospital or office visit in the global with a complication diagnosis if a decision to return to OR was made, but I can't find resources supporting this. Any advice would be greatly appreciated, thank you!

"Treatment for post-operative complications requiring a return trip to the Operating Room (OR). An OR, for this purpose, is defined as a place of service specifically equipped and staffed for the sole purpose of performing procedures. The term includes a cardiac catheterization suite, a laser suite, and an endoscopy suite. It does not include a patient’s room, a minor treatment room, a recovery room, or an intensive care unit (unless the patient’s condition was so critical there would be insufficient time for transportation to an OR);


True Blue
Worcester, MA
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By definition mod 24 is for unrelated E&M. E&M for the complication is related.

Also here is a informational page on modifier 24. Focus on the what is not appropriate for the modifier!

Inappropriate Use
Do not use Modifier 24 when:
· The E/M is for a surgical complication or infection. This treatment is part of the surgery package.
· The service is removal of sutures or other wound treatment. This treatment is part of the surgery package.
· The surgeon admits a patient to a skilled nursing facility for a condition related to the surgery.
· The medical record documentation clearly indicates the E/M is related to the surgery.
· Outside of the post-op period of a procedure.
· Services are rendered on the same day as the procedure
· Reporting exams performed for routine postoperative care.
· Reporting surgical procedures, labs, x-rays, or supply codes.
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