Wiki New to inpatient coding 99231 or 99024--help please

micki127

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Hi,

I am not sure how this should be billed. No one in office knows answer. I hope I can get some quick insight here. Patient is an inpatient at hospital and has been charged for a consult with decision for surgery made now midlevel provider is doing a brief follow-up (99231) the day before surgery. Would that be considered global and should be billed out as a 99024 or is it okay to bill the 99231.

Any advice would be appreciated.

Thank you in advance,
Micki
 
Re: 99231 or 99024

Modifier 57 (the decision to perform surgery) is appended to an E&M the day before or the day of surgery. Many factors to consider: is this a 90 day global procedure?, is the physician just performing a quick pre-op? if so this would be considered in a global period, or is there a different problem unrelated to the surgery. I have included a 57 modifier sheet for reference. Hope that helps!

http://wpsmedicare.com/j5macpartb/resources/modifiers/modifier-57.shtml

Also, 99024, I believe is post-operative, so would not apply the day before the actual procedure.

Josie
 
Thank you but I am still confused.

Patient was seen on 02/14 decision for surgery made on that date. Follow up visit was 02/15 and surgery was 02/17.

How would I bill out the 02/15 visit?
 
Sorry,

I made a mistake the mod 57 was not used on the 02/14 visit (was a consult) but the 02/15 visit is an inpatient visit the day before the surgery for the same condition that the surgery is. So it is not a post op.

How should I correctly code that?
 
Sorry,

I made a mistake the mod 57 was not used on the 02/14 visit (was a consult) but the 02/15 visit is an inpatient visit the day before the surgery for the same condition that the surgery is. So it is not a post op.

How should I correctly code that?

Surgeries with a 90 day global period include an E/M visit the day before the surgery, so there would be nothing to bill, as reimbursement is already included in the next day's surgery payment.
 
if you look at the CPT Surgical Package Definition. E&M subsequent to the decision for surgery on the day before and/or day of surgery (including H&P) are bundled. There are no codes to describe this as its a given that it was done. After the surgery is complete 99024 can be reported for each post op-follow-ups (Its an information only code)
 
Hello everyone,
Posting this to get more clarity on the original header of this thread - Inpatient coding 99231 or 99024?

I am coding for our surgeon for the below scenario.

Our Surgeon performed a major 90-day procedure on 4/15/23.
And he did inpatient subsequent follow up encounters post-surgery until discharge date 4/20/23.

Is it okay to code it as 99231 (99232/ 99233) - based on the level of care, as this is an inpatient service or
Should I code ONLY 99024 here?


Hope one of you can help. Thanks in advance.
 
Hello everyone,
Posting this to get more clarity on the original header of this thread - Inpatient coding 99231 or 99024?

I am coding for our surgeon for the below scenario.

Our Surgeon performed a major 90-day procedure on 4/15/23.
And he did inpatient subsequent follow up encounters post-surgery until discharge date 4/20/23.

Is it okay to code it as 99231 (99232/ 99233) - based on the level of care, as this is an inpatient service or
Should I code ONLY 99024 here?


Hope one of you can help. Thanks in advance.

The answer will depend on what services were documented on 4/20. If the visit was routine post-operative care, then 99024 (or no visit) would be appropriate, but if the services were unrelated to the procedure, then a visit with modifier 24 might be supported. The fact that this is inpatient doesn't necessarily mean that one or the other is correct.

Here is one of the best references for understanding the guidelines for coding during a post-operative global period: Global Surgery Booklet
 
Thank you, Thomas.

This definitely helps.

Is there anyone who doesn't bill these post - op subsequent encounters (4/16 - 4/20) at all, as anyways they will be denied as inclusive under surgical package?
 
Last edited:
It is not required to bill the 99024 services in most states. But, as always, there are exceptions! :) There are 9 states that are required to report global services:


Data Collection on Resources Used in Furnishing Global Services

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) mandated that CMS collect data on the number and level of post-operative visits to enable CMS to assess the accuracy of global surgical package valuation. To help inform accurate valuation of procedures with global periods, Medicare required select practitioners from nine states: Florida, Kentucky, Louisiana, Nevada, New Jersey, North Dakota, Ohio, Oregon, and Rhode Island to report on their post-operative visits (using CPT code 99024) following high volume or high cost procedures beginning July 1, 2017.



I have no experience working in these states. If you do happen to bill in one of the nine I would suggest starting here:
 
Thank you, Thomas.

This definitely helps.

Is there anyone who doesn't bill these post - op subsequent encounters (4/16 - 4/20) at all, as anyways they will be denied as inclusive under surgical package?
I would not recommend billing the visits (unless it is required for reporting purposes as the post above explains) and I've never billed these in any practices I've worked for. Since you know that the surgical fee already includes the payment for these visits, it would be a waste of resources to bill these - including the time spend on coding, follow-up, posting, writing off, dealing with incorrect payments or recoupments, patient inquiries about the bills, etc. Unless the physician or manager specifically wants this done, I would not invest the time in billing these charges to payers.
 
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