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E&M During Post Op Help!!!

  1. Default E&M During Post Op Help!!!
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    I will show the whole history around this and see if you guys can give me some help with the modifiers associated with it.

    on dos 01-10-11 patient was seen for a MRSA and had it lanced.
    Diag: 682.6 041.12 V02.54
    01-10-11 10060

    The next day he was hopsitalized for the MRSA and the same doctor admited, lanced the location again.
    Diag: 682.6 041.12 V02.54
    01-11-11 99222 25
    01-11-11 10060 76
    01-12-11 99231
    01-13-11 99231
    01-14-11 99238

    We are having trouble getting the E&M codes from 01-12-11 to 01-14-11 paid. Are they any appropriate modifiers usable for this situation to get those E&M codes paid???

  2. Default
    Quote Originally Posted by joglesbee View Post
    I will show the whole history around this and see if you guys can give me some help with the modifiers associated with it.

    on dos 01-10-11 patient was seen for a MRSA and had it lanced.
    Diag: 682.6 041.12 V02.54
    01-10-11 10060

    The next day he was hopsitalized for the MRSA and the same doctor admited, lanced the location again.
    Diag: 682.6 041.12 V02.54
    01-11-11 99222 25
    01-11-11 10060 76
    01-12-11 99231
    01-13-11 99231
    01-14-11 99238

    We are having trouble getting the E&M codes from 01-12-11 to 01-14-11 paid. Are they any appropriate modifiers usable for this situation to get those E&M codes paid???
    you will not be paid for the visits for 1/12/11-1/14/11 since the 10060 has a 10 day global. Those visits are considered part of that procedure unless an unrelated situation arose during those days. Then the only thing that can be billed during the global is if there's another procedure or repeat procedure and then of course you would use your modifiers on those. You would have to bill as a no charge/post op visit.

  3. Default
    Couldn't understand why do we need a 76 mod here?

  4. Default
    Quote Originally Posted by srinivas r sajja View Post
    Couldn't understand why do we need a 76 mod here?
    The 10060 was the day before and since it was in the global period you had to use a modifier to get the 10060 paid for the second day on a repeat procedure.

  5. Default
    To answer the general question, the modifier that overrides a global period for E&M codes is 24. Here is an expanded definition of the things included in the CMS global period. Note that a worsening wound that does require in patient admission is NOT included in the global surgical period and can be billed with the modifier 24.

    Postoperative services identified as part of the global package, which are not to be reimbursed separately, include but are not limited to:
    • Dressing changes
    • Local incisional care
    • Removal of operative packs: removal of cutaneous sutures, staples, lines, wires, tubes, drains, casts, and splints
    • Insertion, irrigation, and removal of urinary catheters
    • Routine peripheral intravenous lines and nasogastric and rectal tubes
    • Change and removal of tracheotomy tubes
    Wound complications that do not require additional trips to the operating room or a hospital admission

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