E/M During Global Period

amartinez1

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I have a patient that was seen 6weeks after surgery knee arthroscopy with debridement of the patellofemoral joint due to arthritic changes and gouty crystal he also had other procedures done. The visit was in the office and my physician wants me to code an office visit E/M because he diagnosed patient with patellar tendinitis and arthritis of the knee. An injection was also administered at this visit. I beleive I can only code for the injection but not the office visit since it pertains to the same knee operated on. Does anyone have any suggestions?
 

kathydaniel

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If the surgery was performed due to the arthritis and the injection was given for the same issue, yes you are correct you can only bill for the injection & drugs. Make sure you add a modifier 58 on the injection since you are within the global period. If this is Medicare, you can only bill the drugs as Medicare has a different global package definition from CPT which only reimburses for a return to the OR during the global period.

If I misunderstood your post, and the surgery was for a different issue than the arthritis, you can bill for the E&M with a mod 24 and a mod 79 on the injection.
 

amartinez1

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Surgery was for a torn meniscus but when he was in the knee joint arthritis was seen and debrided does this still mean that the E/M can not be billed? There was also a different diagnosis of patellar tendinitis at the time of office visit
 
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