Wiki E/M Modifier w/Surgery


Adel, IA
Best answers
I have a question an Iowa Medicare Denial. The patient came into the ER with a dislodged feeding tube- I billed out the E/R visit for it. Then, that evening, he came back and the physician did mild dilation of gastrostomy tract and gastrostomy tube re-insertion. I billed out for the procedures that time and put a 25 modifier on the E/R visit from that morning. Medicare is denying for the procedure codes. Is this correct and that I can't bill for the procedures even though the E/R visit and the procedures were 12 hrs apart?
Sounds like the patient is in a Global. If that's the case you won't be able to charge for the E/R visit if your Dr/Group of same specialty see's the patient unless you can justify modifier -24 as unrelated to global. The dilation/re-insertion won't be billable unless it was done in the OR or a certified procedure room. If it was, you will use -78 on the procedure and -24 & -25 (if justified) on the E/M. If not done in OR, it will be considered part of the global.
Yea it would be related. Darn it. The surgeries were twice as expensive as the ER visit. Would it be a good idea to send back the ER visit and bill for the procedures instead?