Wiki Modifier 24-Is it appropriate if

[amym]

1. Is it appropriate if a patient comes in for a follow-up, post pacemaker implant, to not only look at the wound, interrogate the pacemaker but also address their hypertension and other conditions them may have and bill with a -24 modifier?

2. What about if the reason for the visit are due to complications from the pacemaker implant?

 

[twizzle]

1. Is it appropriate if a patient comes in for a follow-up, post pacemaker implant, to not only look at the wound, interrogate the pacemaker but also address their hypertension and other conditions them may have and bill with a -24 modifier?

2. What about if the reason for the visit are due to complications from the pacemaker implant?

You can bill an E&M visit if the patient comes in to have their hypertension addressed, with a modifier 24. This only applies if the patient is coming in for this problem or any new problem they may have, unrelated to any reasons the pacer was placed.

If they only come in to have the wound checked it is a post-op visit and not billable, although the interrogation is.

If they have a complication due to the pacer, such as a malfunction of a lead then additional work-up would be needed to diagnose the problem and you can bill the E&M with a modifier 24 providing the diagnosis is different to the one for the pacer implant.

Your provider needs to dictate a good report because all claims with a modifier 24 require records be submitted.

 

[Watkins.Jess]

Would I bill an E/M with -24 if the patient came in for F/U for PPM and he not only addressed the surgical site but he also addressed his underlying conditions and did a EKG.

The way it is documented now is 99213-25 and 93010

Not sure if it should be 99024-25 and 93010

Any insight on this would be greatly appreciated.