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Post op modifier

shruthi

Guru
Messages
135
Location
Mysore, Karnataka
Best answers
0
If suppose patient had major surgery on 5/2/12 which has 90 days global period, and subsequent care was done on 5/3/12 and dicharged on 5/5/12 what modifier should we use on subsequent and discharge codes.
47563 -- 5/2/12 -- Paid
99232 -- 5/3/12 -- Denied
99238 -- 5/5/12 -- Denied
We are getting denials for subsequent and discharge codes stating, payment is included in the allowance for another service or procedure (Dx is same).

Need advice.

Thank you.
 

mitchellde

True Blue
Messages
13,538
Location
Columbia, MO
Best answers
2
If your provider performed the surgery then the post visits are global and cannot be modified. Hopefully the post diagnosis is different from the surgical dx though!
 

thaish

Guest
Messages
1
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0
well I`d say to use 99024(pg. 529) for the follow-up E/M code, just to show it was done because it is within the global period, you wont get any money for it though ;)
 

shruthi

Guru
Messages
135
Location
Mysore, Karnataka
Best answers
0
I do agree that patient will be in global period, but due to which how can we not bill patients subsequent and discharge codes rather bill only 99024? Just confused...
 

mitchellde

True Blue
Messages
13,538
Location
Columbia, MO
Best answers
2
The subsequent and discharge are already paid for with the reimbursement for the surgery and the patient part is paid when they pay their copay/coinsurance/deductible. You may not charge for visits related to the surgery, for 90 days post surgery when it is a major surgery. The 99024 is a no charge ( or at most a $.01, which must be adjusted off) visit just to communicate that a post op encounter occurred.
 

shruthi

Guru
Messages
135
Location
Mysore, Karnataka
Best answers
0
Thanks Debra. Got your point.
So its all about the concept of surgical package, post op services will be included in surgical package and should not be charged separately.
 
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