Please help a biller settle a dispute with surgeon!!

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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
 
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 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!!
 
Because 28510 is a surgery code with 90 day global, and the decision was made to do the fracture care during the e/m visit, I would place a 57 for decision for surgery on the e/m as well as a 25 due to the x-ray.
 
agree and desagree

I agree with 25 modifier. 57 wouldn't apply because a it wasn't suggested to have surgery only an X ray. As far as the 24, although, the patient will enter into a global period of the surgical code; the post operative period doesn't starts until midnight of the day of the surgery. Hope it helps
 
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