Post-Op Question


Fort Myers, FL
Best answers
Hey Everyone!

We just coded a patient with melanoma. The patient just came in for his first post-op visit. The provider is charging a level because he is sending the patient to a specialist, ordering scans, labs, etc. I was always under the impression that there was no charge for the post-op within the time period, etc. but my co-worker says that he is doing extra.

Any thoughts???

You can only bill an E&M during a post op period if the visit is unrelated to the original procedure, in which case you would use modifier -24. Also modifier -24 requires a different diagnosis. But no matter how much "extra" work is done, if it's related to the original procedure you should not bill an E&M.

Zaida, CPC
zaidaaquino, This what I always say too if it is related anyway to the procedure and you did not do another procedure then it is global.

But I have one question, why do you find that to use -24 that you have to have a different diagnosis? I have tried to find it but can't.

Jessica Harrell, CPC
Well, if you are going to use -24 modifier, you need to show that the E&M is unrelated to the procedure that has the global period. How would you show it's unrelated if you use the same diagnosis or if you use one that is related to the procedure? Of course, your documentation must show the E&M is unrelated. I found some great examples in a Medicare manual called Primary Care Training Manual dated 7/2/08, pages 20, 21. (Go to I think you may find it useful. Hope this helps...;)

The visit is Global

To answer your first question ... the visit IS global to the surgery UNLESS the reason for the visit is completely unrelated. (He might have ANOTHER lesion on the same part of the body ... DX might be the same, but it's still unrelated to the lesion that was removed.)

By the way, lesion removal (even melanoma) has only a 10-day global (unless he did a tissue transfer CPT 14000-14300, then it's 90 days).

F Tessa Bartels, CPC, CPC-E/M