Question Modifier

loftuskr

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What modifier should you use if a patient comes into your office under post op care and the doctor that sees her is not the surgeon who did her surgery? This patient was seen in our office when her surgeon was out of the office.
 

skiboi

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What modifier should you use if a patient comes into your office under post op care and the doctor that sees her is not the surgeon who did her surgery? This patient was seen in our office when her surgeon was out of the office.
My first question would be are they of the same specialty?
 

csperoni

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If they are the same group, same specialty, it is not billable & included in postop care.

From the Medicare global surgery brochure:
The global surgical package, also called global surgery, includes all the necessary services normally furnished by a surgeon before, during, and after a procedure. Medicare payment for a surgical procedure includes the pre-operative, intra-operative, and post-operative services routinely performed by the surgeon or by members of the same group with the same specialty. Physicians in the same group practice who are in the same specialty must bill and be paid as though they were a single physician.
https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/GloballSurgery-ICN907166.pdf
 

vanessamoldovan

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What modifier should you use if a patient comes into your office under post op care and the doctor that sees her is not the surgeon who did her surgery? This patient was seen in our office when her surgeon was out of the office.
Regardless of who the surgeon was.....If the patient is being seen within the global surgery period for the original procedure: for a followup visit related to the original procedure, then it can only be billed as 99024 with $0. If the patient is being seen for a problem/reason that is unrelated to the original procedure, then an office visit can be billed with modifier 24. I hope this adds additional light. Not sure what your specific scenario is. One more thing: if the patient is being seen outside of the global surgery period of the original procedure, then an established visit may be billed and no modifier is necessary.
 

csperoni

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I think this gets tricky. Her surgeon was paid for the global surgery package, which would include the postop care. If her surgeon did not provide the postop care, should not have billed global, and your office should have billed only for postop.
Sometimes practices (especially solo or small practices) have a reciprocal arrangement with another practice to cover vacations, etc. For example, they each agree to cover 3 weeks for the other practice. In that situation, you would not bill for this, as it is part of the reciprocal agreement.
 

loftuskr

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Thank you all for your input. We are resubmitting the claim with Modifier 24 since it is separate service under PO period. We were just unsure since it is a different doctor from the patients surgeon.
 

csperoni

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I do not think that is correct.
Basically, if the visit is unrelated to the surgery (or otherwise excluded from the global package), no modifier would be required, since it is a different group.
If the visit IS related to the surgery, there are a lot of additional questions/scenarios that determine if it is billable.
 

bdcoyne8

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I'm not sure it would be appropriate to add the modifier 24 as it specifically states "same physician". As she was not the surgeon who performed the procedure, it would not be acceptable. This is a tricky one. I guess you really need to ask yourself if the medical necessity is supported to bill the E/M service. Why did the performing provider send the patient to this other provider? Is this something that is typically done in this practice? I can understand the provider sending the patient to the PA in the same practice, but not physician to physician in different clinics of the same specialty.. I know.. not much help.. sorry!
 
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