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Modifier- indicates patient needs

  1. Default Modifier- indicates patient needs
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    Patient comes in has a bx, results come back and indicates patient needs treatment of bx site for scc. Patient comes back in one wk to get site treated, what modifier is used?

  2. #2
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    Quote Originally Posted by janstin@tampabay.rr.com View Post
    Patient comes in has a bx, results come back and indicates patient needs treatment of bx site for scc. Patient comes back in one wk to get site treated, what modifier is used?
    Most skin biopsies don't have global periods, so no modifier should be required for the treatment.

    If the biopsy is one with a global period, and the treatment date is within 10 days of the date the sample was taken (not from when the results came back), then the modifier used will depend on the CPT code used to describe the treatment.

    You'd need a 24, if it's an E/M, or 58 if it's a procedure code. Hope that helps!

  3. Default
    Quote Originally Posted by btadlock1 View Post
    Most skin biopsies don't have global periods, so no modifier should be required for the treatment.

    If the biopsy is one with a global period, and the treatment date is within 10 days of the date the sample was taken (not from when the results came back), then the modifier used will depend on the CPT code used to describe the treatment.

    You'd need a 24, if it's an E/M, or 58 if it's a procedure code. Hope that helps!
    what type of biopsy has a global period? most treatments are within the 10 day period of the sample being taken. I am a little confused as to what type of procedures in the global package

  4. #4
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    Quote Originally Posted by janstin@tampabay.rr.com View Post
    what type of biopsy has a global period? most treatments are within the 10 day period of the sample being taken. I am a little confused as to what type of procedures in the global package
    I don't know for sure - more than likely, it's for those that require a more invasive collection method (like colon or stomach, but I'm just guessing...)

    The global package is on the green page right before the surgery section in your CPT book. (Under "Suregery Guidelines" - if you have an AMA Professional Edition, it's on page 52) It spells out what is included, but doesn't go into details on what's not included. If it's not on the list, then it's not part of the package.
    Think of the package like a product you buy, that comes with a limited set of accessories . Basically, when Medicare (or another payor) "buys" the surgery described by a CPT code, they're buying everything that's required to accomplish that surgery. Basic anesthesia (local or topical), a pre-op evaluation (not to be confused with the 'decision for surgery' encounter), immediate post-op care, writing orders, evaluating the patient in post6-anesthesia recovery, and typical post-op care. When a payor authorizes a surgery, they're giving the OK to do all of those things, and they pay for them all at once.
    Complications can't be predicted for every patient; some people have them and some don't, but it's certainly not something that's expected every time. This article may be useful to you:
    http://skinandaging.com/article/8379

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