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Injury during global period

amartinez1

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I have a patient that had operation performed on her suhoulder. It is still during the global period and she had a fall that caused her to have increased pain. Am i allowed to bill for an e/m visit since he had to reevaluate the situation and take xrays to determine if she caused further damage and append the modifier 24 with the e code to describe the recent fall?
 

lostone65

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It depends on the payer. If it is Medicare they consider ANYTHING on that body part to be included in the global. Private payers have their own rules about this. If it is a private payer I would bill it with the modifer 24 and the pain diagnosis. I also include the E code for fall so that they understand what happened. Then you waitto see if they will or will not pay accodeing to policy.
 

cblack712

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I would use the 24 modifier. Medicare will pay this as long as you have documentation indicating that it is not related. At a CMS seminar I attended about a year ago the question to ask is would you do the same for another patient that isn't in the global period? If yes than you can evaluate to make sure that if medicare requests the documentation you can support your use of the 24 --- in your case the patient re injured her arm -- here is an excerpt from the CMS manual
"if it was
provided during the postoperative period of a surgical procedure, furnished by the same
physician who performed the procedure, billed with CPT modifier “-24,” and
accompanied by documentation that supports that the service is not related to the
postoperative care of the procedure. They do not pay for inpatient hospital care that is
furnished during the hospital stay in which the surgery occurred unless the doctor is also
treating another medical condition that is unrelated to the surgery. "
 
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