kathydaniel
Networker
I'm drawing a blank on this one and any help would be greatly appreciated. If a patient is seen during the post op period and has an exacerbation of the problem we can bill for the E/M correct? And if so, is it modifier 24?
-
If this is your first visit, be sure to check out the FAQ & read the forum rules. To view all forums, post or create a new thread, you must be an AAPC Member. If you are a member and have already registered for member area and forum access, you can log in by clicking here. If you've forgotten your username or password use our password reminder tool. To start viewing messages, select the forum that you want to visit from the selection below..
Wiki post op question
- Thread starter kathydaniel
- Start date
RebeccaWoodward*
True Blue
It will probably boil down to carrier guidelines. Do they follow Medicare or CPT global guidelines.
CPT=typical post-op f/u care
CMS=includes post op complications unless there is a return to the OR -if completely unrelated, modifier 24 would be appropriate with the E/M code.
CPT=typical post-op f/u care
CMS=includes post op complications unless there is a return to the OR -if completely unrelated, modifier 24 would be appropriate with the E/M code.
kathydaniel
Networker
If they follow CPT (does anybody?) then I wouldn't need a modifier? None of the modifiers seem to fit this issue. It's related to the surgery but is an "un-typical" issue.
There is a good article on this in the May 2010 Coding Edge, pages 26 thru 29(CMS vs. CPT & Define the Global Surgery Package). But it sounds like it would still boil down to which guidelines the insurance goes by and you would have to know which guidelines they go by before using a mod 24. If I'm not mistaken, I think this article mentioned attaching a letter of explanation. The only thing I'm really sure about is you can't bill Medicare for this. Hope the article helps.
kathydaniel
Networker
That's a great article. I don't know how I missed when I read through it. Thanks for pointing it out!