Wiki Mod -24 question (cross posting)

[Jessim929]

I know -24 mod is "E&M for new ailment during post op global period". We see a lot of kidney/ureteral stones. Some procedures have a 90 day global (ESWL - 50590 and PCNL 50080/50081 are two that come to mind). If the op note states the stone is dusted/gone/etc. but patient returns during the global period with a new stone, that's a new ailment, right?

Thanks!

 

[amyjph]

Without seeing the notes, if the stone is new it would not be part of the global period for one that was already addressed, in my opinion.

 

[csperoni]

-24 is not just for a new ailment during a global surgery period. CMS has a great reference with their global surgery booklet. Unfortunately, it is apparently currently under revision and not available. I did have this information saved from it.
The following services are not included in the global surgical payment. These services may be billed and paid for separately:
• Initial consultation or evaluation of the problem by the surgeon to determine the need for major surgeries. This is billed separately using the modifier “-57” (Decision for Surgery). This visit may be billed separately only for major surgical procedures.
• Services of other physicians related to the surgery, except where the surgeon and the other physician(s) agree on the transfer of care. This agreement may be in the form of a letter or an annotation in the discharge summary, hospital record, or ASC record.
• Visits unrelated to the diagnosis for which the surgical procedure is performed, unless the visits occur due to complications of the surgery
• Treatment for the underlying condition or an added course of treatment which is not part of normal recovery from surgery
• Diagnostic tests and procedures, including diagnostic radiological procedures
• Clearly distinct surgical procedures that occur during the post-operative period which are not re-operations or treatment for complications
• Treatment for post-operative complications requiring a return trip to the Operating Room (OR). An OR, for this purpose, is defined as a place of service specifically equipped and staffed for the sole purpose of performing procedures. The term includes a cardiac catheterization suite, a laser suite, and an endoscopy suite. It does not include a patient’s room, a minor treatment room, a recovery room, or an intensive care unit (unless the patient’s condition was so critical there would be insufficient time for transportation to an OR).
• If a less extensive procedure fails, and a more extensive procedure is required, the second procedure is payable separately.
• Immunosuppressive therapy for organ transplants
• Critical care services (CPT codes 99291 and 99292) unrelated to the surgery where a seriously injured or burned patient is critically ill and requires constant attendance of the physician.

 

[amyjph]

For sure, agree. If we are talking definitions "E&M for new ailment during post op global period" is not technically the definition of modifier 24.
Modifier 24: Unrelated Evaluation and Management Service by the Same Physician during a Postoperative Period.
The physician or other QHP may need to indicate that an evaluation and management service was performed during a postoperative period for a reason(s) unrelated to the original procedure. This circumstance may be reported by adding modifier 24 to the appropriate level of E/M service.

The Modifier 24 fact sheets on the various MAC sites are helpful too. https://www.novitas-solutions.com/webcenter/portal/MedicareJH/pagebyid?contentId=00101583
You can search in the claims processing manual for info too: https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/clm104c12.pdf

 

[Jessim929]

Without seeing the notes, if the stone is new it would not be part of the global period for one that was already addressed, in my opinion.

That's my logic as well, I just wanted to make sure I wasn't overthinking it.

 

[quinn1234@tampabay.rr.com]

Based on the aforementioned comments, if a patient who completed XRT for Lung cancer (C34.11) was recently diagnosed with Brain Mets (C79.31), a -24 modifier may not be required for E&M visit during the 90 day global period. At least that's how I interpreted the definition. Would that be a reasonable assertion? Thank you.

 

[csperoni]

If the visit is to evaluate the mets/progression of disease that may now require additional treatment and documented as such, then it is not part of the global surgical package. -24 would be required to indicate this.