Wiki modifier 58 and E/M

[jcoder1]

patient had two surgeries., The 2nd surgery, a related procedure that required a return to the OR- which I added modifier 58. In between the two surgeries there was an E/M. My question is if the 2nd procedure was planned is the E/M billable and not included in the global period(99024)?

and to go one step further, in the case where the 2nd procedure was not planned and modifier 78 applied, would the E/M in between the surgeries be billable, and not included in the global period?

 

[dclark7]

As long as the E/M is related to the original surgery it is not billable, only the subsequent procedures which require a trip to the O.R. are payable (by Medicare).

Some insurances may pay E/M for complications, but you would have to check the policy for each payer, Medicare will not pay unless the visit is unrelated to the surgery.

 

[jcoder1]

thank you very much, I thought that was the case but wasnt 100%.