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Modifier 24 but different physician???

  1. #1
    Location
    Fayetteville, NC
    Posts
    300
    Question Modifier 24 but different physician???
    Medical Coding Books

    I have a real stumper here. We are being denied the office visits for a patient who had surgery elsewhere, wasn't happy with the results, and decided to come to us for another opinion. Subsequently we saw her several times. Our denials are due to the golbal period for the procedure the other physician did. Is there any modifier I can use?
    Modifier 24 specifically states that it is used for the "same" physician during the global period????

  2. #2
    Default
    Try -55 Postoperative management only

  3. #3
    Location
    Fayetteville, NC
    Posts
    300
    Default
    Even if we didn't make an agreement with the former physician to manage this patient?
    And we aren't strictly managing her previous condition.

  4. #4
    Location
    Columbia, MO
    Posts
    12,531
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    55 must be appended to the surgical code provide by the surgeon and there must be a transfer of care request on the chart. Meaning the surgeon must either write an order for the patient to follow up with you or request directly that you take over care. Otherwise this is elective patient decision and must be billed to the patient, the payer has already paid the surgeon for the global and the surgeon (it sounds like) had every intention of performing the post op, the patient however had other independent thoughts so it is patient decision. Think of it this way if you had your hair cut and after leaving the salon you absolutely hated what you had and decided to go to another salon to have it fixed, then you would have to pay again whereas if you went back to the same person they would be obligated to fix it without charge.

    Debra A. Mitchell, MSPH, CPC-H

  5. #5
    Location
    Fayetteville, NC
    Posts
    300
    Default
    Thanks that is what I was afraid of as this is a Medicaid patient

  6. #6
    Location
    Columbia, MO
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    12,531
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    She should go back to the original surgeon if she is unhappy and if he can do nothing then she could complain to the state, what kind of surgery was this and what is her complaint?

    Debra A. Mitchell, MSPH, CPC-H

  7. #7
    Location
    Fayetteville, NC
    Posts
    300
    Default
    She had a lap chole, an EGD, and a colonoscopy elsewhere and came to us because she still had epigastric pain, spasms, nausea, and vomiting. We saw her a few times in the office and twice in the hospital. no procedures were performed and every one of our claims were denied as global. We ended up refering her to a gastroenterologist. (We are General, Vascular, and Throacic surgeons)

  8. #8
    Location
    Columbia, MO
    Posts
    12,531
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    So your visit were in the global of the lap chole? If she were still having those issues then that definitly should go back to the original surgeon that did the lap chole. Sorry this type if thing is very hard for well meaning physicians.

    Debra A. Mitchell, MSPH, CPC-H

  9. #9
    Location
    Fayetteville, NC
    Posts
    300
    Default
    I just got off the phone with a Medicaid Rep and he told me to append a 24 even though we are not the same physician who performed the procedure??
    I'm going to try it but the CPT and Medicare specifically state that 24 is for when the SAME physician provides care in the global period....

  10. #10
    Location
    Columbia, MO
    Posts
    12,531
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    I think that is really bad advice. Clearly this is surgery related and is part of global, unfortunately it is too late to get a transfer of care. My opinion but I firmly believe this should be converted to patient responsibility.

    Debra A. Mitchell, MSPH, CPC-H

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