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Modifier during global period?

  1. #1
    Default Modifier during global period?
    Medical Coding Books
    I had a similar situation not too long ago but with a Medicare patient. This pt has Anthem. This pt went to E.R. b/c he fell and got glass in his knee. (did not see us in E.R.) pt came to us for follow up E.R. visit since we are family md, still glass in knee so we dr did an I & D. He came back for a follow up on this and Dr sent him to a specialist b/c there was still problems with his knee. specialist request surgery b/c there is still glass in the knee. Pt comes here for pre-op clearance (this is policy of local hospital, surgeon is not doing h&P). is there a modifier that would be appropriate to bill for this during a global period?

  2. #2
    Milwaukee WI
    Default Mod 24 is for UNRELATED E/M
    Well, the -24 modifier is for an unrelated E/M service in the postoperative period ... so I don't think that would apply, since it's the same problem.... UNLESS ... see below

    You say that the reason the patient is coming to you now is "hospital policy" and that the surgeon isn't doing an H&P. Why isn't the surgeon doing the H&P; the surgeon is being paid for the H&P as it is part of the RVUs of the procedure. The surgeons I work for do their own H&Ps; they are, after all, legally and medically responsible for the patient during this admission for surgery.

    If the procedure you performed was CPT 10120 or 10121 then there is only a 10-day global period ... if you're outside the 10-days you don't need a modifier at all.

    If the surgeon is requesting a consultation on co-morbidity issues (perhaps your patient has HTN or DM or ??) then you could code a consultation with the -24 modifier (as the HTN or DM would be your dx and that is unrelated to having glass in the knee).

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

  3. #3
    well said Tessa
    adrianne, cpc

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