Wiki Use of 56501

[Kswindler20]

We had a patient come in for a visit on 01/21/2021 - treatment #1 and 01/28/2021 - treatment #2, both for 99213 - MOD. 25 (OFFICE/OUTPATIENT VISIT EST) and 56501 (DESTROY VULVA LESIONS SIM). My billing system is not letting me submit and showing me the following errors..

"Pattern 20920 Procedure Code 99213 is within the global period of 10 days of History Procedure Code 56501 performed on 01/21/2021 on Claim ID 144376-0012477617, Line ID 12875300 by the same provider. Please review documentation for appropriate modifier."
"Pattern 8293 Procedure Code 56501 is within the global period of 10 days of History Procedure Code 56501 performed on 01/21/2021 on Claim ID 144376-0012477617, Line ID 12875300 by the same provider. Please review documentation for an appropriate modifier."

Does anyone know what modifier I need to use?

 

[csperoni]

1) I am highly suspicious of your second 99213 on 01/28/2021.
56501 has a 10 day global. Unless the visit on 01/28/2021 was unrelated to the procedure, it would be included in global. IF (big IF) it was not related to the surgery, I would bill 01/28/2021 E/M with both -24 and -25 and a separate dx.
I am only mildly suspicious of your E/M on 01/21/2021.
2) Your second 56501 is again, in the global period. Depending on the exact reason and circumstances a second procedure was done, there are options that include:
-58 Staged or related procedure or service by the same physician during the postoperative period. Modifier 58 indicates performance of a procedure or service during postop period was either:

• Planned prospectively at the time of the original procedure (staged);
• More extensive than the original procedure; or
• For the therapy following a surgical procedure

-78 Return to the Operating Room for a Related Procedure During the Postoperative Period
The physician may need to indicate that another procedure was performed during the postoperative period of the initial procedure. When this subsequent procedure is related to the first, and requires the use of the operating room, it must be reported by adding the CPT modifier 78 to the related procedure.

-79 Unrelated Procedure or Service by the Same Physician During the Postoperative Period
The physician may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. This circumstance must be reported by using the CPT modifier 79. For repeat procedures on the same day, see CPT modifier 76.

https://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7LRQJM7400

And I cannot stress enough to read through and understand the CMS Global Surgery booklet. And then read it again. And if you're not sure, read it again. I STILL refer to it. https://www.cms.gov/outreach-and-ed...oducts/downloads/globallsurgery-icn907166.pdf