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Modifier 24-I work for a General

  1. #1
    Question Modifier 24-I work for a General
    Medical Coding Books
    Hi All,
    I work for a General Surgery practice, and a discussion between me and my coworker recently came up that I would like everyones opinion on. We have a patient that was seen for a breast mass, and subsequently had a breast biopsy done, which came back positive for breast cancer. Our surgeon has seen the patient again and would like to bill a E&M code during the post operative period, suggesting that since it is a new diagnosis code (breast mass vs breast cancer) this can be done with modifier 24. Any thoughts?
    Erin Toavs

  2. #2
    Milwaukee WI
    Default Nice try but ...
    Nice try ... but I'm not buying it. The -24 modifier is for an UNRELATED reason. This is clearly related to the mass that was biopsied.

    By the way I'm assuming the the original biopsy was coded as CPT 19101, which has a 10-day global period. All other biopsies have a -0- day global period.

    F Tessa Bartels, CPC, CEMC

  3. #3
    Columbia, MO
    Totally agree with Tessa!

  4. #4
    Default Modifier 24
    Thanks for the input guys!
    We came across an article from The American College of Surgeons that states, "Often services are provided during the global surgery period but are unrelated to previous surgery. The most obvious sample is an office visit to explore treatment options during the postoperative period of a breast biopsy. In this instance, report the appriopriate offive visit, established patient, with a modifer 24 (indicating an unrelated evaluation and management service by the same physician during a postoperative period)". Here's the link to the article..
    The plot thickens

  5. Default mod 24
    You can bill for disease management in the post-op period. If the patient returned to the office to now discuss management of her breast cancer, you can bill for that. When leveling the service, you would not include any of the post-op care documentation, only the disease management part.

    I bill for this in our Thoracic clinic when a lung biopsy comes back positive for cancer.

    Lisi, CPC

  6. #6
    Default Thanks!
    Thanks so much for post Lisi, this is very helpful

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