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underlying condition

  1. #1
    Default underlying condition
    Medical Coding Books
    When Medicare states that within the global period you cannot charge for complications of the surgery unless brought back to the operating room...only "underlying" conditions can be billed. What does that mean. I have one - colon resection - then a few weeks later admitted to hospital for small bowel obstruction. Patient did not have surgery, just a hospital stay to monitor the obstruction. Can we charge for this? Confusied.

  2. #2
    To get out of the global period and bill for the E/M services in this scenario you would have to use the 24 modifier. So does your documentation support a 24 modifier?

    Based on what you posted I would say in this case it probably doesn't. If the provider is dealing with anything related to the procedure you are in the global period for you can not use the 24.

    Do some research on the 24 modifier and I think this will help with your confusion. Not sure where you are but WPS Medicare has a lot of good info on modifiers.

    Laura, CPC, CPMA, CEMC

  3. #3
    Thank you Laura - fine line sometimes...

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