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Thread: Post Op Situations

  1. #1
    Join Date
    Apr 2007

    Default Post Op Situations

    AAPC: Back to School
    Our group of surgeons is having trouble capturing their charges when it involves post op visits. I have a few scenarios where there is difficulty in capturing what was done. Anyone's help would be greatly appreciated.

    1. Breast Biopsy pt who returns two weeks after the biopsy to discuss her newly diagnosed cancer.The visit involves over 30 min of pt discussion and arrangement for further surgery for her cancer including wide excision lumpectomy and SLN biopsy. (Our front desk sometimes records this as simply a post op).
    2. In-pt who had surgery for acute cholecystitis but remains hospitalized due to anemia, diabetes, ileus and possible partial bowel resection.POV or a visit as his medical course deviates from a routine Gall bladder with other new or co morbid problems which require management?
    3. Elderly Pt with malignant effusion who undergoes thoracoscopic drainage and biopsy.Post operatively requires ongoing management of chest tubes for drainage and medical problems. POV or Visit as the surgery was non-curative and palliative approach and did not correct primary presenting problems.
    4. Pt seen in the office 2 months after uneventful colon resection for diverticulitis with new complaints of enlarging subcutaneous mass on his back which will require out-patient surgical removal.
    5. 35 yo MRSA thigh abscess debrided bedside during his hospitalization who returns two weeks later for office follow up and further wound care.
    6. 51 yo enigmatic epigastric pain with biliary dysfunction with numerous complaints pre-op and 12 days following uneventful in-patient cholecystectomy including chest pain, abdominal pain, bloating. Pot op, further CT imaging obtained along with outpatient office visit requiring 35+ minutes with Pt and wife again reviewing all the pre-op work up and future management options. Clearly not a routine post op gall bladder but can/should it recorded otherwise?


  2. #2
    Join Date
    Apr 2007
    Milwaukee WI

    Default 24 modifier

    The 24 modifier is used to identify the unrelated E/M in the postoperative period.

    The question is "what is unrelated?"

    For a long time (back when I was first coding) anything that wasn't routine postoperative care merited the -24 modifier. So infections got a -24 modifier because that was not considered "routine" postoperative care.

    But Medicare will not pay for any infections, including those that require a re-hospitalization for IV antibiotics - UNLESS there is a return to the OR. And even then Medicare will pay only for the procedure, not for any of the E/M.

    Medicaid and several commercial insurers are following Medicare's lead on this issue.

    If your documentation supports that the E/M is unrelated to the procedure and you are still in the postoperative period, then use the -24 modifier. Be prepared for the possibility of a denial and the need to appeal.

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

  3. #3
    Join Date
    Apr 2007


    Thanks! That is exactly what I was looking for. Have a great day!

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