# MDM Post Op Appendicitis



## jifnif (Jan 25, 2010)

I have a note that is a subsequent visit.  I am trying to decide on MDM and the note is very vague.  I have a 7/YO 1 day post op appendectomy and the plan is to advance activity and diet w/ a CC of pain.  Nothing is done for pain or at least not noted.  I don't know where to give credit for medical decision making.  In my opinion it is minimal due to the fact that nothing was really done but b/c the pt is post op does that give you a higher MDM?  Thanks for any advice.


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## mitchellde (Jan 25, 2010)

This falls under global and can be charged as a 99024 if you were the surgeon and if not then it is the surgical code plus the 54 modifier as this is a post op encounter.


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## jifnif (Jan 25, 2010)

I don't do the coding for this specific group, I am just doing some audits but...this particular group uses subsequent visits when visiting a pt in the hospital post op.  Your saying this should be a 99204 as opposed to a 99231-99233?


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## mitchellde (Jan 25, 2010)

Yes or no code at all.  If they were paid it should not have been this sounds like a post op management visit which is part of global.  Was this done by the surgeon or PCP?  Either way from what you said of the documentation it was for post op purpose.


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## jifnif (Jan 25, 2010)

This is definitely a visit from our surgeon (the PA-C) and the CC is for pain.  I am new to surgery and I am not sure on where I stand in the way of telling them they are doing it wrong but if they are I would like to understand so I can present the argument.  Thanks for pointing this out to me but just so I understand more clearly, as long as the surgeon is doing a follow up for post op regardless of place of service you would bill a 99204?  Thanks for being so helpful and patient!


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## mitchellde (Jan 25, 2010)

That is how I have always coded it.  99024 is not a place of service specific code and it goes with a $0.00 charge.  Pain is ordinary after surgery and the surgeon is expected to address this issue as a part of the global package.  How have they been getting paid?  I am most surprised that these were not being denied or were they appending a 24 modifier?  It is always hard to tell a physician it has been coded incorrectly when they have been getting paid!


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## jifnif (Jan 25, 2010)

I am not sure if they are getting paid or not.  I would hope not considering it is during the post-op period.  I will definitely be finding out though.  Thanks so much for your help.


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## FTessaBartels (Jan 25, 2010)

*Still inpatient vs outpatient*

To make life easier on ourselves we do NOT code any postoperative visits by the surgeon performing the procedure while the patient is still inpatient (or short stay).  

We use the 99024 for every follow-up office visit with the surgeon during the global period. 

If the patient is seen by another specialty or a physician of another practice while still in hospital following surgery, the appropriate hospital visit codes would be used. (The global period applies only to the surgeon who performed the procedure - or any other providers in the same practice with the same specialty.)

Most procedures (and virtually all that would require an inpatient stay) carry a 10 or 90 day global period. All postoperative management is included in the fee for the procedure, so the surgeon (or another physician or PA or NP of the same specialty and same practice) should not be billing for these services. They will all get denied and skew your receivables and write-offs.

Hope that helps.

F Tessa Bartels, CPC, CEMC


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