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Thread: Modifier 24 or not

  1. #1

    Default Modifier 24 or not

    AAPC: Back to School
    I am not a 100% sure how to answer my surgeons questions and would love to hear others thoughts on the subject. Scenario...my surgeon performs Lithotripsy (90 day global and all stones are gone) on a patient but wants the patient to come back in during the global period to have a metabolic work-up and to educate the patient on stone prevention. He wants to charge the patient for an office visit and append modifier -24 with dx code of history of stones and believes this should get paid because the patient is not coming in with the problem any longer. Your thoughts on this is much appreciated.

    Thanks for your help!

  2. #2
    Join Date
    Apr 2007
    Sioux Falls South Dakota


    This is still related to the surgery and therefore not billable, IMHO. I would consider this typical postoperative care - only complications, exacerbations, recurrence, or the presence of other diseases or injuries would warrant charging for an E/M.
    Lucinda (Cindy) McGarry, CPC-P
    Applications Specialist
    Avera Health Plans
    Education Office Sioux Falls SD Local Chapter
    Past President Sioux Falls SD Local Chapter

  3. #3


    Thanks! That is what I thought too but just wanted some verification.

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