Avoid Denials for Unrelated Postop E/Ms with Modifier 24

Posted on 9 Nov, 2015 |comments_icon 7|By Chris Boucher
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Modifier separates E/M from normal surgical aftercare.

When you’re coding for your provider’s surgical services, you’ll need to be familiar with modifier 24 in case the same provider performs an unrelated E/M service on the same patient during the postoperative (global) period.

Avoid E/M denials during the postop period with this expert advice on what to do when a patient reports for a problem unrelated to a recent surgery.

Append 24 to Unrelated Postop E/Ms During Global

Use modifier 24 (Unrelated evaluation and management service by the same physician or other qualified health care professional during a postoperative period)) if the physician who performed a surgical procedure “sees the patient during the postoperative period for an [E/M] service unrelated to the surgery,” says Suzan (Berman) Hauptman, MPM, CPC, CEMC, CEDC, director of PB Central Coding at Allegheny Health Network in Pittsburgh, Pa.

If the patient reports for any unrelated E/M that occurs during a postop global period — including hospital visits, office visits, etc. — you must append modifier 24, confirms Celia Forde, CPC, CPCH, coding specialist for Florida’s Centra Care, which has offices in the Orlando area.

See also: Rely On Modifier 54 When You’re Breaking Up Fracture Care

Example: The physician performs a complicated incision and drainage (I&D) to treat a carbuncle on the patient’s left thigh on Monday (10061, Incision and drainage of abscess [e.g., carbuncle, suppurative hidradenitis, cutaneous or subcutaneous abscess, cyst, furuncle, or paronychia]; complicated or multiple). On Wednesday, the patient returns to the office complaining of pain in her right shoulder after playing tennis.

The physician who performed the earlier I&D examines the new shoulder injury and sends the patient home with instructions on treatment. Notes indicate a problem-focused history, an expanded problem-focused exam, and low-complexity medical decision making.

For the Wednesday E/M service, report 99213 (Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: an expanded problem focused history; an expanded problem focused examination; medical decision making of low complexity) with modifier 24 appended to show that the E/M was unrelated to the patient’s recent I&D surgery.

Explanation: Four facts make this E/M service modifier 24 eligible:

  1. The same provider who performed the I&D performed the shoulder injury E/M.
  2. The global period for 10061 is 10 days.
  3. The patient reported for treatment of her shoulder injury during the global period for 10061 (two days later).
  4. The shoulder injury E/M was completely unrelated to the I&D of the thigh.

Author

Chris Boucher


Chris Boucher has nearly 10 years of experience writing various newsletters and other products for The Coding Institute. His blog will cover several areas of coding and compliance, including CPT® coding, modifiers, HIPAA compliance and ICD-10 coding.

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7 thoughts on “Avoid Denials for Unrelated Postop E/Ms with Modifier 24

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