Wiki Decision for Surgery within global period

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Hello Fellow Coding Professionals

Patient had surgery for greater tuberosity fracture with shoulder dislocation and is in the office during the global surgery. There is a displacement of the greater tuberosity fragment and a decision for ORIF is made. Is this a billable E and M since the diagnosis is slightly different? Or would you stick with 99024?

Thank you
 
Hi Sparkles! I do not believe that you can charge for the E/M even with a 57 modifier. The reason I think this is because you would have to use a modifier 24 to the E/M code to break the bundling issue with the global period the patient is currently in. According the CPT book, in order to use a modifier 24, "The E/M must be unrelated to the original procedure." In this case, the patient is being treated for a greater tuberosity fracture, that has since displaced. So this would not be considered unrelated. Even though the diagnosis has gone from non displaced to displaced, they are still in a global for the same greater tuberosity fracture. I wouldn't code out the E/M, but I would definitely put a modifier 58 on the surgery. I hope this helps.
 
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