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24 modifier

  1. Question 24 modifier
    Exam Training Packages
    Can I append a 24 modifier to E/M code for a patient seen in the post op period who developed a post op wound infection that requires antibiotics to treat that infection? I would consider this a complication and should not be billed; however, another person is telling me that "this is not part of the normal recovery from surgery" and, therefore can be billed.

    Another example. Pt is seen in post op period and has non-healing wound but has diabetes as a complicating factor, could I in this situation use a 24 modifier?

    Appreciate any advice. Thanks


  2. #2
    Kingsport, TN
    We do minor procedures in our office and occasionally a patient will develop an infection post op. I code the E/M with the 24 modifier and also add the infection diagnosis codes (key info). I have had no problems with getting paid. Hope this helps.

  3. #3
    North Carolina
    If it is a Medicare patient, no. However, I would attempt using modifier 24 with non-medicare patients. CPT global guidelines vary a little from Medicares.

    CPT's Surgical Package
    According to CPT, the surgical package includes the following:

    -The surgical procedure;
    -Local infiltration, metacarpal/ metatarsal/digital block or topical anesthesia;
    -One related evaluation and management (E/M) encounter (including history and physical) that occurs after the decision for surgery has been made and is either on the date immediately prior to the procedure or on the actual date of the procedure;
    -Immediate postoperative care, including dictating operative notes and talking with the family and other physicians; Writing orders;
    -Evaluating the patient in the postanesthesia recovery area;
    -Typical postoperative follow-up care.

    Medicare's View

    -Preoperative visits after the decision is made to operate beginning with the day before the day of surgery for major procedures and the day of surgery for minor procedures;
    -Intraoperative services that are a usual and necessary part of a surgical procedure;
    -All additional medical or surgical services required of the physician during the postoperative period of the surgery because of complications not requiring additional trips to the operating room;
    -Follow-up visits during the postoperative period of the surgery that are related to recovery from the surgery;
    -Postsurgical pain management;
    -Certain supplies;
    -Miscellaneous services (e.g., dressing changes; local incision care; removal of operative packs; removal of cutaneous sutures and staples, lines, wires, tubes, drains, casts and splints; insertion, irrigation and removal of urinary catheters, routine peripheral intravenous lines, nasogastric and rectal tubes; and changes and removal of tracheostomy tubes).

  4. #4
    I am still a CPC-A at this time and short on experience, however, I recall my coding teacher telling us that sometimes docs will treat their pt one time for a non-healing surgical wound (because they can not charge for the E/M - global package). Then if further treatment is needed they will refer them to a "wound clinic" at the local hospital. Differnet doc, different charge, pt gets needed treatment. Everyone wins. Sounds logical to me.
    K Kelley, CPC-A

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