E/Ms during Global Period

adri3421

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I have an unusual situation I am trying to find clarification on.

I am auditing for surgeons who perform trauma surgeries and then who also serve as hospitalists managing all the patient's other injuries/underlying conditions. They bill all these followup visits using -24 modifier.

It is really hard to separate the postoperative work from the work involved in managing these other injuries/conditions when reviewing the documentation.
Everything is lumped together.

What recommendations should I make to ensure that if a payer reviewed these records the -24 modifier would be deemed appropriate?
 

Andys

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Mod 24 - is used for unrelated problems during the global period

If the follow up visit was for same problem then billing mod 24 is inappropriate. If E/M service is given for same problem then it is included in the global period of that procedure.

Mod 24 can only be billed if the physican sees any new problem which is not related to the surgery or procedure perfomed previously.

The thing that payer will look for is appropriate documentation (which states the E/M service was unrelated) & different diagnosis.

Hope this helps..!!!!
 

mitchellde

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we always have them document 2 notes one for the post op and then open a new note note for anything unrelated to the post op. This kept is very clean especially if 2 different payers get involved such as work comp for the injuries and medical for all other issues.
 

adri3421

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I am pretty sure -24 can be billed for treatment of unrelated conditions or underlying conditions.

I am dealing with underlying injuries. For example, on a multiple trauma pt my doctor does an exploratory laparotomy & bowel resection, but then is also managing rib fractures, pelvic fracture, hypertension, diabetes. These are underlying conditions that are not typically managed by the surgeon. These are separately identifiable conditions/injuries that are unrelated to the initial surgery required for a bowel injury. So we do have different diagnoses.

Do we just need to make sure the documentation relating to these other dx needs to really be beefed up to make it clear we are providing more than typical postop care?
 

Andys

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Yes, documentation is the key.

Documentation must clearly explain what all things were done that too in a proper way.

If your physician spends additional time in managing all these diagnoses (rib fractures, pelvic fracture, hypertension, diabetes). He must report them in assement plan & if possible, also have a work up plan for them.


Andy S
 
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