Wiki TCM eligible during Post Op Period ... modifier use

[marandee]

Hello All,

Regarding appropriate modifier for a TCM within the global surgery period. Claim denied due to document request as well as modifier missing. Services were verified, so now just a question of appropriate modifier. Industry notes I've gathered recommend surgical code with appended modifier -55 but TCM are services I need to bill... this is not strictly post op due to surgery but transitional care management related to hospital then rehab discharge and I would like to append modifier -24. Does this make sense? The TCM was for Rehab discharge but still within postop period and patient has other conditions to consider.

Truly appreciate any advisement / thoughts. - Marandee

 

[thomas7331]

Modifier 55 on the surgical code is not appropriate unless there was a transfer of care where a physician in one practice performed the surgery and then transferred the patient to a different practice for the post-operative care and it does not sound like that is your situation.

It's hard to advise whether the modifier 24 is appropriate or not without seeing the documentation. The global surgery guidelines say that E&M that are related are not separately payable, but those that are unrelated can be billed with the modifier 24. But if you're saying that the service was 'not strictly post op due to surgery' that suggests that part of it may be related to the surgery and part of it not. I would just recommending reviewing the documentation and asking whether or not you could use it to support an appeal if needed to explain that these TCM services were unrelated to the surgery and above and beyond what would normally have been provided to the patient as part of their post-operative care. If that's the case, then the modifier 24 would be appropriate and should be sufficient to get the service paid.

 

[marandee]

Thank you Thomas. I will appeal with documentation as you make a good point of these services being above and beyond normal post op care.
Much appreciated - Marandee

 

[AnneBT]

TCM service done by provider other than surgeon

If the patient is in the hospital for a planned procedure, can a different provider other than the surgeon charge for TCM? My patient had back surgery and now the internal medicine provider is wanting to charge for TCM services.

Thank you,
Anne Terribilini CPC