Wiki Office visits in the post-op period

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kparkhurst

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Here's the situation:
Pt has cataract surgery on the rt eye. Pt comes in for post-op visit. Billing sheet lists post-op visit and office visit w/mod. 24 - same dx. I have not yet requested the notes on this but I'm guessing that the office visit being charged is for the lt eye. Upon review of previous billing, this practice has done this quite frequently. Some insurances have even paid. Am I right to be very concerned????
 
You should be concerned. Modifier 24 indicates unrelated evaluation and management in the post op period. You should definitely verify this on the documentation. If the practice has been billing these post op visits incorrectly and getting paid, the takebacks are surely coming.
 
I certainly would be, hopefully when you get the documentation all will be correct, but you have to investigate to be sure.

I am a firm believer in better safe than sorry.

Laura, CPC, CEMC
 
Thanks for the help - I guess I should have been a little more specific - would billing an office visit for the other eye be acceptable? Even if surgery on both eyes was the established plan on the very first visit? There are some cases where there is another dx billed, but I'm guessing that the reason for the patient visit is the post-op visit and he routinely looks at the other eye as well and then bills for it. I've requested the notes.
 
Possibly, depends on what was done and the medical necessity of it.

The other eye would not be included in the global period, it would qualify for the 24 modifier.

The issue I would have is if they already decided to do surgery on the 2nd eye when the initial decision was made, what is being done/documented to justify another visit?

I know that is a vague answer but without seeing documentation it is really hard to say. This isn't a clear cut scenario.

Laura, CPC, CEMC
 
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