Results 1 to 6 of 6

Office visits in the post-op period

  1. #1
    Default Office visits in the post-op period
    Exam Training Packages
    Here's the situation:
    Pt has cataract surgery on the rt eye. Pt comes in for post-op visit. Billing sheet lists post-op visit and office visit w/mod. 24 - same dx. I have not yet requested the notes on this but I'm guessing that the office visit being charged is for the lt eye. Upon review of previous billing, this practice has done this quite frequently. Some insurances have even paid. Am I right to be very concerned????

  2. #2
    Location
    Capital Coders, Columbia, SC
    Posts
    145
    Default
    You should be concerned. Modifier 24 indicates unrelated evaluation and management in the post op period. You should definitely verify this on the documentation. If the practice has been billing these post op visits incorrectly and getting paid, the takebacks are surely coming.

  3. #3
    Default
    I certainly would be, hopefully when you get the documentation all will be correct, but you have to investigate to be sure.

    I am a firm believer in better safe than sorry.

    Laura, CPC, CEMC

  4. #4
    Default
    Thanks for the help - I guess I should have been a little more specific - would billing an office visit for the other eye be acceptable? Even if surgery on both eyes was the established plan on the very first visit? There are some cases where there is another dx billed, but I'm guessing that the reason for the patient visit is the post-op visit and he routinely looks at the other eye as well and then bills for it. I've requested the notes.

  5. #5
    Default
    Possibly, depends on what was done and the medical necessity of it.

    The other eye would not be included in the global period, it would qualify for the 24 modifier.

    The issue I would have is if they already decided to do surgery on the 2nd eye when the initial decision was made, what is being done/documented to justify another visit?

    I know that is a vague answer but without seeing documentation it is really hard to say. This isn't a clear cut scenario.

    Laura, CPC, CEMC

  6. #6
    Default
    Thanks, Laura. That is pretty much what I thought, but backup is always good!

    Kathy

Similar Threads

  1. office to inpatient post-op visits
    By hjenni4024 in forum Podiatry
    Replies: 0
    Last Post: 03-27-2014, 08:58 AM
  2. Visits during the Global Period
    By AR2728 in forum E/M
    Replies: 4
    Last Post: 03-19-2013, 03:35 PM
  3. Post op visits vs. chargable visits
    By conniecoder in forum Billing/Reimbursement
    Replies: 0
    Last Post: 06-26-2012, 09:22 AM
  4. Replies: 2
    Last Post: 06-26-2009, 01:53 PM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •  
Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?

Login

Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.