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post op question

  1. #1
    Columbus, OH
    Default post op question
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    I'm drawing a blank on this one and any help would be greatly appreciated. If a patient is seen during the post op period and has an exacerbation of the problem we can bill for the E/M correct? And if so, is it modifier 24?

  2. #2
    North Carolina
    It will probably boil down to carrier guidelines. Do they follow Medicare or CPT global guidelines.

    CPT=typical post-op f/u care
    CMS=includes post op complications unless there is a return to the OR -if completely unrelated, modifier 24 would be appropriate with the E/M code.

  3. #3
    Columbus, OH
    If they follow CPT (does anybody?) then I wouldn't need a modifier? None of the modifiers seem to fit this issue. It's related to the surgery but is an "un-typical" issue.
    Kathy Daniel, CPC, COSC

  4. #4
    There is a good article on this in the May 2010 Coding Edge, pages 26 thru 29(CMS vs. CPT & Define the Global Surgery Package). But it sounds like it would still boil down to which guidelines the insurance goes by and you would have to know which guidelines they go by before using a mod 24. If I'm not mistaken, I think this article mentioned attaching a letter of explanation. The only thing I'm really sure about is you can't bill Medicare for this. Hope the article helps.

  5. #5
    Columbus, OH
    That's a great article. I don't know how I missed when I read through it. Thanks for pointing it out!
    Kathy Daniel, CPC, COSC

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