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E/M within global surgery package - BEFORE

  1. #1
    Default E/M within global surgery package - BEFORE
    Medical Coding Books
    Patient was seen on the 5th for consultation. Surgeon and patient make the decision for surgery and schedule it for the 10th. On the 9th, the patient comes in for an unrelated problem. Since the 9th will be in the global surgical package, it's going to get denied without a modifier but -57 wouldn't be appropriate because decision was made prior and -24 would be appropriate because that's only for post-op. Suggestions?

  2. #2
    Default
    Quote Originally Posted by schweppeme View Post
    Patient was seen on the 5th for consultation. Surgeon and patient make the decision for surgery and schedule it for the 10th. On the 9th, the patient comes in for an unrelated problem. Since the 9th will be in the global surgical package, it's going to get denied without a modifier but -57 wouldn't be appropriate because decision was made prior and -24 would be appropriate because that's only for post-op. Suggestions?
    Submit the claim with records - no modifier. Hope that helps!

  3. Default
    The claim should be payable without a modifier as long as the diagnosis supports that it is an unrelated problem

    Diana

  4. Cool
    it would hardly pay without appending modifier. submit with modifier 24 in case of different dx as you are telling the patient was present with unrelated problem.

  5. #5
    Default
    Quote Originally Posted by nikhil.jain608@gmail.com View Post
    it would hardly pay without appending modifier. submit with modifier 24 in case of different dx as you are telling the patient was present with unrelated problem.
    You don't use modifier 24 during the pre-op period, only the post-op period. Since this was a day before the surgery, there is no modifier available to describe the situation. Unrelated E/M's that occur during the pre-op period are payable without a modifier; however, providers may be required to submit medical records to show that the visit was really unrelated to the procedure, and not a pre-op clearance visit, which is included in the global surgical package. When an unrelated E/M occurs the day before a scheduled surgery, it is recommended that providers submit medical records with the claim, since they will inevitably be requested anyways. Hope that makes sense!

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