Results 1 to 7 of 7

What Modifier

  1. #1
    Default What Modifier
    Exam Training Packages
    Please help. What if any modifier can be used in this situation.
    Inpatient Medicare initial 99223 by Dr. A 10/2/11 for occlusion and documentation clearly states decision for surgery and it was scheduled, so a 57 modifier was added. Dr. B (same specialty) did the surgery 10/3/11(90 day global). Now here's the question; additional diagnostic tests were run and they called Dr. A back in on the morning of the 10/3/11 for Cholecystitis. What modifier could be used to get Dr. A paid for 10/3/11 because decision for surgery was made the day before and he did not do the gallbladder surg, they decided to wait. Would a 24 modifier work even though the surgery was scheduled but not yet performed by Dr. B? Thanks for your help as always

  2. #2
    Location
    Manhattan, NY
    Posts
    390
    Default
    Seems adding modifier 24 to the inpatient follow-up E&M should be fine.... Don't forget to indicate in the note surgery was postponed due to this complication (cholecystitis), and use the appropriate ICD-9.
    Last edited by hewitt; 11-01-2011 at 09:59 AM. Reason: mispelled word

  3. #3
    Default
    Thank You for your quick response but i have one question. The original surgery was not postponed. The Leg/Occlusion surgery was done but after Dr. A saw the patient for chole which they did not do because of the other surgery done by Dr. B. I hope I am not confusing you.

  4. #4
    Location
    Manhattan, NY
    Posts
    390
    Default
    Thank you for clarifying.... I think modifier 24 would be fine....

  5. #5
    Location
    Tacoma, WA
    Posts
    1,087
    Default
    Quote Originally Posted by NESmith View Post
    Thank You for your quick response but i have one question. The original surgery was not postponed. The Leg/Occlusion surgery was done but after Dr. A saw the patient for chole which they did not do because of the other surgery done by Dr. B. I hope I am not confusing you.
    I would think just using the 24 modifier on the E/M visit by Dr A for the evaluation of the cholecystitis. There will be a different diagnosis code than what the surgery was being done for so hopefully that will clarify the claim.
    Arlene J. Smith, CPC, CPMA, CEMC, COBGC

  6. #6
    Default
    Thank You once again for your response but I have one more question. The description for the 24 modifier states: Unrelated Evaluation and Management Service by the Same Physician During a Postoperative Period but would this still be appropriate since the procedure has not been done and the patient would not be in postoperative period or would it be correct because it would be considered in the Global on the 90 day procedure? i only want to do what is correct.

  7. #7
    Location
    Baton Rouge
    Posts
    1,239
    Default
    Quote Originally Posted by NESmith View Post
    Thank You once again for your response but I have one more question. The description for the 24 modifier states: Unrelated Evaluation and Management Service by the Same Physician During a Postoperative Period but would this still be appropriate since the procedure has not been done and the patient would not be in postoperative period or would it be correct because it would be considered in the Global on the 90 day procedure? i only want to do what is correct.
    Modifier 24 is appropriate, because the additional E/M service (for cholecystitis) on 10/3 is unrelated to the surgery that was done earlier that morning. Use of the modifier 24, along with the different diagnosis, will support this info on the claim.

    Hope this helps clarify!
    Meagan Strauss, CPC, CEMC
    Coding Coordinator
    The NeuroMedical Center
    Baton Rouge, LA

Similar Threads

  1. Replies: 2
    Last Post: 09-18-2015, 02:17 PM
  2. Modifier 59 vs Modifier 91 for Laboratory
    By leahrey in forum Modifiers
    Replies: 1
    Last Post: 06-23-2015, 01:01 PM
  3. MODIFIER PT VS MODIFIER 33 Screening Colonoscopy
    By Ann Johnson in forum Modifiers
    Replies: 2
    Last Post: 07-19-2012, 08:08 AM
  4. Modifier 58 versus Modifier 78
    By Ramona03 in forum Medical Coding General Discussion
    Replies: 2
    Last Post: 06-04-2012, 01:10 PM
  5. Modifier 51 Versus Modifier 59
    By Sborkowski in forum Modifiers
    Replies: 3
    Last Post: 05-26-2009, 04:59 PM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •  
Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?

Login

Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.