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Thread: Please Help Me!

  1. #1
    Join Date
    Apr 2007
    Jackson, Mississippi

    Default Please Help Me!

    AAPC: Back to School
    The patient had a surgery done on 09/01/10. The patient had to go to the ER for a complication and was seen there by different physician in our group on 9/4/10. Which modifier do I use or can this physician charge for this service? This physician also charged for 99238 on 9/7/10. Which modifier do I use for this also? Please. please, please help. I've never had to code for this. Thanks in advance for your help.

  2. #2
    Join Date
    Apr 2007
    Milwaukee WI

    Default Read Appendix A

    Read Appendix A of the CPT book which describes all the modifiers.

    NOTE: Medicare will not pay for any visits during a global period, including ER or hospital admission. Not even for complications. Medicare will cover returns to the OR for additional procedures but not E/M codes.

    Some Medicaid or commercial carriers may cover visits for services "unrelated" to the procedure. We have had some success using the -24 modifier for such cases in the past, but more and more carriers are following CMS.

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

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