Wiki Post-Op vs Established Pt?


Albany, GA
Best answers
We are having issues with a claim and determining if it should be considered as a post-op visit during a 90-day global period, or billable as an established patient visit code. The patient in question had a 90-day orthopedic procedure done on his hand, and was being seen during the following month for follow-up. He was also examined and advised on an unrelated injury to his wrist during the same visit. Basically, the question is should we use 99024 or 99213-24? Any input would be appreciated.
Post op vs unrelated

If your doctor did an actual exam, and this was a new problem [wrist injury], then yes, you should bill for the visit with the modifier 24. I would separate the charges,
99024 on one claim for the post op visit, and the new problem, including date of injury, on another claim.

I just had a post op patient that had a DVT, and this was a billable service, as it was above and beyond a normal, post op visit. I used the modifier 24 with DVT diagnosis and the insurance paid the claim with no problem. I did check with a certified coder also, and this was correct to do.

Hope this helps.

Because this is a separate injury and not related to the surgery, you should code it as an established patient visit with the 24 modifier for this visit. Without the documentation of a separate injury, then you wouldn't be able to.