# Cardiology surgery and discharge codes



## Kathy J.Washburn (Aug 12, 2013)

Question:

Would modifier -24 used with discharge CPT code 99239 be appropriate in the scenerios below?

1)

Patient is admitted for bradycardia and AV block.
A permanent pacemaker implantation was performed.
The discharge diagnoses are atrioventricular block, post status chamber pacemaker, nonsustained ventricular tachycardia, atrial tachycardia and was discharged on atenolol after the pacemaker implantation. 
The provider would like to report CPT code 99239 which was documented in the chart as 35 minutes of time spent is discharging the patient.  
Would modifier -24 be appropriate?

2)

Patient is admitted for lightheadedness.
A permanent pacemaker implantation was performed.
The discharge diagnoses are symptomatic bradycardia and atrial fibrillation, and was discharged on atenolol after the pacemaker implantation.
The provider would like to report CPT code 99239 which was documented in the chart as 35 minutes of time spent in discharging the patient.
Would modifier -24 be appropriate?


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## jewlz0879 (Aug 14, 2013)

Not in my opinion. 24 states it must be for _Unrelated E&M service_ I don't see how it was unrelated. If even one of those dx are submitted with the 99239 and were also submitted with the PM implant - more than likely, it will be denied. 

Unfortunately, the discharge is included and just because he spent 35 minutes discharging the patient really has no bearing on appropriate use of 24; it must not be related. If you feel the documentation is strong enough to support modifier -24 for an appeal - go for it. I've honestly never tried to attach 24 to a discharge. 

Unrelated Evaluation and Management Service by the Same Physician During a Postoperative Period: The physician may need to indicate that an evaluation and management service was performed during a postoperative period for a reason(s) unrelated to the original procedure. This circumstance may be reported by adding the modifier 24 to the appropriate level of E/M service.

An excision of a malignant lesion on the left arm is performed in the office on January 10, 2009. The ICD-9-CM diagnosis code reported is 171.2. The post-operative period designated for excision code 11606 is 10 days.

The patient returns to the office on January 15, 2009 and is treated for contact dermatitis, ICD-9-CM code 692.0. The physician should report the appropriate evaluation and management code followed by the 24 modifier, e.g., 9921224.

In order for the evaluation and management service to be payable in the post-operative period with the 24 modifier, the diagnosis code supporting the E/M service must be different from the diagnosis code reported for the previously performed surgery.

Modifier 24 should not be used for the medical management of a patient by the surgeon following surgery. Medicare recognizes modifier 24 only for the care following a discharge. 

https://www.novitas-solutions.com/claims/coding/modifiers/modifiers.html

HTH


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## Kathy J.Washburn (Aug 22, 2013)

*Discharge with modifier 24*

Thank you, Julie.  That was quite an explanation.  I agree totally.


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