# Complication in global period Modifier 24 for E&M



## coffee2day (May 20, 2017)

Hello, 

If a patient develops post op infection during the global period, say pacemaker infection and returns to the OR, is it correct that we cannot bill the e&m hospital visits with modifier 24 still? I am getting mixed advice.

From reading the medicare guide, it reads to me that only the return procedure can be billed, and that "it does not include a patient's room". Which makes me think we cannot bill the e&m hospital visit with modifier 24  for a complication, is this correct? Some say that we can bill an e&m in an hospital or office visit in the global with a complication diagnosis if a decision to return to OR was made, but I can't find resources supporting this. Any advice would be greatly appreciated, thank you!

 "Treatment for post-operative complications requiring a return trip to the Operating Room (OR). An OR, for this purpose, is defined as a place of service specifically equipped and staffed for the sole purpose of performing procedures. The term includes a cardiac catheterization suite, a laser suite, and an endoscopy suite. It does not include a patient’s room, a minor treatment room, a recovery room, or an intensive care unit (unless the patient’s condition was so critical there would be insufficient time for transportation to an OR);


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## CodingKing (May 21, 2017)

By definition mod 24 is for unrelated E&M. E&M for the complication is related.

Also here is a informational page on modifier 24. Focus on the what is not appropriate for the modifier 

https://www.novitas-solutions.com/w...-state=rjhz45cu2_4&_afrLoop=2384446196945000#!

*Inappropriate Use*
Do not use Modifier 24 when:
·        The E/M is for a surgical complication or infection. This treatment is part of the surgery package.
·        The service is removal of sutures or other wound treatment. This treatment is part of the surgery package.
·        The surgeon admits a patient to a skilled nursing facility for a condition related to the surgery.
·        The medical record documentation clearly indicates the E/M is related to the surgery.
·        Outside of the post-op period of a procedure.
·        Services are rendered on the same day as the procedure
·        Reporting exams performed for routine postoperative care.
·        Reporting surgical procedures, labs, x-rays, or supply codes.


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## coffee2day (May 21, 2017)

Thank you so much


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