Wiki Modifiers

[kendall43130@gmail.com]

Hi, I am new to this specialty and not familiar with all the modifiers. I have a claim that was denied due to it was in a global period and it was performed by a Dr. that is in another practice (however we have combined 7 practices together this year, not all under the same roof but under the same Tax ID and NPI#). So I need to know what modifier I would use for in global period by different Dr. and it is for same issue (cataracts) she did and office visit and now she has scheduled a revision. Please let me know your thoughts.
Thanks
Kelly

 

[Cheezum51]

Not sure I understand what you're asking. I believe what you are saying is that the patient is in their global post op period (90 days) and was seen by another doctor in the practice for an issue related to their surgery and that visit resulted in some type of revision procedure being scheduled.

If that's the case, it doesn't matter who saw the patient in the practice, since you use a common group Tax and NPI identifier, it isn't a billable visit because it's included as part of the post op care for the cataract surgery.

If the doctor did see the patient for a non surgery related problem during the post op period, then you would use the 24 modifier for that office visit on the CPT exam code.

Tom Cheezum, OD, CPC, COPC

 

[kendall43130@gmail.com]

Thanks i will try it is hard to put into words how our office is at this time. We as a group went into a corporation i guess you could say with 7 other offices to get a better deal with things like insurance for their employees and 401ks and things like that, however it has been a struggle to work out the kinks cause all the doctors from the other groups are now under the same NPI and tax ID and if we see them and send them as a referral then they see them it is not counted as a new patient for them cause we have seen them under the same numbers. It is very hard to bill for them with 7 other practices also billing out for their doctors. But thank you for your advice I guess I was just over thinking it.