E/M in global period

[colorectal surgeon]

I occasionally run into this situation. Patient is sent to me with a rectal polyp (211.4). Patient undergoes transanal excision (45171) with 90 day global. Path shows rectal cancer (154.1). Post op discussion is very different involving discussion of a low anterior resection and occasionally chemotherapy or radiation. Can I bill these office visits with a 24 modifier? Thanks

 

[dadhich.girish]

IMO, these OV's should not be coded, although the resultant surgeries, which seem to be larger than the original one, can be coded with modifier 58 with a new global period. Others' views are welcome.

 

[Mojo]

Treatment for an underlying condition or an added course of treatment that is not part of the normal recovery from surgery is not included in the global surgery package. If the office visit is for the counseling on treatment options and expectations, not an evaluation of the postop site or care, an E/M with modifier -24 is appropriate.


Per WPS on Modifier 24:
If sufficiently documented, use Modifier 24 when furnishing an E/M service that is exclusively for treatment of the underlying condition and not for post-operative care.

Trailblazer:
Office visits during the postoperative period are not covered unless they are submitted with modifier 24 to indicate they are unrelated to the surgery. Modifier 24 is primarily for use only by the surgeon. A different diagnosis code may be sufficient to show the procedure is unrelated to the surgery; however, it may not be required. Documentation submitted should fully explain how the E/M service is unrelated to the surgical procedure.

Check out this article:
http://codinginstitute.blogspot.com/2011/04/for-post-op-disease-counseling-consider.html

 

[colorectal surgeon]

Thanks so much! Great reference!