Wiki Dermitology modifier 24 and 25 combination ??

[cwalker042]

I just started coding for a derm practice and have a few questons regarding modifiers:

1) Provider performs procedure with global period. A few days later patient comes back in for another procedure (different area of the body) and the doctor codes an E&M with the procedure. Now, the doctor does not mention this issue in the previous office note which is why he is coding an E&M along with the procedure. We bill out the E&M with a 24 mod and 79 on the procedure and the carriers are denying inclusive. If we put a 25 mod on the E&M the carriers deny for being part of the global surgical package. I've been told that we are not supposed to put a 24 and a 25 on an E&M visit. Please share your thoughts/experiance with this.

2) Doctor performs MOHS (no global) and a different provider within the same practice does the complex repair who is a plastic surgeon which has a global period. When patient, again, comes back for another procedure (different area of the body) the doctor who performed the MOHS (no global) is billing an E&M with a 25 and a procedure. Carriers are denying as being part of the global surgical package. It's my understanding that it doesn't matter who the doctors are, if they are within the same practice, same TIN, the services provided in the global period will need the appropriate modifier. Can someone clairfy this for me

3) lastly, When we bill an add on code the carriers are denying as being inclusive. For example, we bill 99203-25, 11100-59, 11101, 17110, 40490. They paid the 11100 but denied the add on code as being inclusive. I always though we do not need 59 mods on add on codes?

Thanks for any feedback you can give me. It is greatly appreciated!

 

[thomas7331]

If modifiers 24 and 25 both apply, then both should be used - not sure why you were told not to use those together, but they will definitely both be required to prevent a denial if you are in the global period and on the same day as a procedure.

For two providers in the same practice, if the specialty is the same, then the global period will apply - most payers treat two providers of the same specialty as the same provider. If the specialties are different, then you should not need a modifier to exempt the procedure from the global period of the other provider's surgery. However, different payers have different ways of assigning specialties, and I've also seen some payers try to apply the global period outside of the specialty if the claim appears to be related, so my experience has been that there's no sure way to know what a payer will do in every situation like this. In some cases you may have no choice but to appeal these denials if your documentation supports it.

Regarding the add-on codes, in theory there should be no need for a modifier on the add-on code if you've put one on the base code, but in practice, some add-on codes are set up to bundle to other codes in the NCCI tables. So if that's case for a particular code pair, then you will need to add the modifier to bypass the bundling.

Hope this helps!

 

[cwalker042]

It does, thank you very much!!!