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Use of modifier 24 help...Please!

  1. #1
    Default Use of modifier 24 help...Please!
    Medical Coding Books
    A patient had a lap sigmoidectomy on 2-4-2011 for perforated diverticula. On 3-9-2011 one of our general surgeons saw the patient in the hospital for a consult because the patient was having abd pain. The dr states in the dictation that postoperatively she is doing well, having regular bowel movements, denied any blood or dark colored bowel. His assessment at the end of his consult is suspected colities, possible stenosis.

    Can I put an inpt consult code with mod 24????

    Thanks for any help.

    Stacey Sands
    CPC

  2. #2
    Wink
    Quote Originally Posted by asasands View Post
    A patient had a lap sigmoidectomy on 2-4-2011 for perforated diverticula. On 3-9-2011 one of our general surgeons saw the patient in the hospital for a consult because the patient was having abd pain. The dr states in the dictation that postoperatively she is doing well, having regular bowel movements, denied any blood or dark colored bowel. His assessment at the end of his consult is suspected colities, possible stenosis.

    Can I put an inpt consult code with mod 24????

    Thanks for any help.

    Stacey Sands
    CPC
    One question:
    Does your patient have Medicare or Tricare? If so, you should select an inpatient hospital visit code, instead of a consult code.

    To answer your question, you don't use a modifier unless your doctor was also the surgeon that operated on the patient; if that's the case, I would add a 24 modifier, but only because there's not any indication that it's a complication of the surgery (as opposed to an infection), so it's technically an 'unrelated' E/M service. If it had been a complication, then you wouldn't put any modifier on it, but you'd still bill it - just send documentation with the claim. This website explains it pretty well...
    http://www.wpsmedicare.com/part_b/ed...lsurgery.shtml

    Hope that helps!

  3. #3
    Location
    Milwaukee WI
    Posts
    4,466
    Default Same specialty, Same practice?
    First ... you have a patient in the postoperative period for abdominal surgery. I would argue that "abd pain" is a related diagnosis.

    So ...

    Is the surgeon who saw the patient for the abd pain of the same specialty and same practice as the surgeon who operated? (I'm assuming it's not the same surgeon.)
    If YES ... then this is a global visit... 99024.
    If NO ... then you can code without any modifier (the global period covers only the surgeon who operated ... or any of his/her colleagues with the same specialty in the same practice).

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

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