Wiki Please help a biller settle a dispute with surgeon!! - cortisone injection

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arickord23

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I am having a debate with my surgeon over appropriate E&M modifiers and I need some tie breakers!!

A patient was seen today for follow up to RT shoulder pain. (No sx, no fracture, has cortisone injection in February) Today's visit we recommended MRI to RT shoulder to evaluate continued pain after PT and injection.
During this visit, he states that he stubbed his toe a few days ago.
Xrays of the RIGHT foot taken in the office today demonstrate a nondisplaced oblique fracture through the diaphysis of the proximal phalanx of the 5th toe.

We are billing the E&M for the shoulder: 99214
foot xray: 73630 &
fracture care for the toe: 28510

We are "debating" the appropriate E&M modifiers. 24? 25? Both??

Please help!!

Thanks!
Andrea
 
I don't think you would use a -24. That is for an E/M service performed during a post op global period that is not related to the surgery. Check out Appendix A in the back of your CPT coding manual for a detailed description of each modifier. :)
 
RIGHT! That is what I tried to explain and he states that we are now in a post op period bc we charged the fracture care today so the post op period would technically start today. I didn't think it worked that way but he got me all flustered! So I went searching for some backup!!
 
I guess I never thought about it like that. But the global period actually begins on the day of the procedure. Which would indicate that you should add 24 & 25 both.
 
No to Modifier 59.. injection only has 10 day global.. I would use 25 as, fracture is seperate from office visit.
 
I agree post op for the injection of steroid/drug for rt shoulder in February does not have a global period extending to the present. No modifier 24 needed. Also post operative period for fracture care of foot won't start until next day. I would just use the modifier 25 on the E\M. As long as you properly link your diagnosis codes to the right procedures you should be good, or at least accurate. Cathy:)
 
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