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Confused Modifier 24 to be or not to be???

  1. Default Confused Modifier 24 to be or not to be???
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    Hi, I've been racking my brain and researching this online through AAPC, other websites, Medicare, etc and I'm not quiet satisfied with the answers. I have a pt that came in two days after a laceration repair (10 day global). The provider has documented the wound is now infected and even took out sutures for drainage and stopped the pt on antibiotics. The provider charged out an office visit.

    Would this be correct to append modifier 24 or no? i keep reading if it's complications, such as infections, then you can bill out a separate em w/OUT mod. But i'm also reading you can bill WITH a mod. which one is iT? then i read medicare guidelines considers this within the global. the insurance pt has is private, cigna. i was going to bill out an office visit with a complicated wound dx (now that it's infected) w/OUT the mod.

    Last edited by mizzmaryb; 10-19-2010 at 02:18 PM.

  2. #2
    Most insurances will consider this to be part of the global package. Check your Cigna contract to see if they follow Medicare guidelines. Medicare says that post-op complications are considered part of the global package unless it requires a return to the operating room.

  3. Default

    It should be billed with 24 modifier or else it would be get chance of denial.Since the wound is complicated we can code it
    Nandha CPC

  4. Default
    ah, i see it goes both ways. haha. thank you all. i will see what i can find out from cigna!

  5. #5
    Charleston, WV
    Modiefier 24 is to be used when the post-op visit is unrelated to the original procedure. An infection at the surgical site is related so 24 would not be appropriate. Treatment of a post-op wound infection is considered part of the post-op care package.

  6. Default
    The infected wound is still within the 10 days global.

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