# Post-Op Question



## Ltoth (Sep 25, 2008)

Hey Everyone!

We just coded a patient with melanoma.  The patient just came in for his first post-op visit.  The provider is charging a level because he is sending the patient to a specialist, ordering scans, labs, etc.  I was always under the impression that there was no charge for the post-op within the time period, etc. but my co-worker says that he is doing extra.

Any thoughts???

Lisa


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## zaidaaquino (Sep 25, 2008)

You can only bill an E&M during a post op period if the visit is *unrelated *to the original procedure, in which case you would use *modifier -24*.  Also modifier -24 requires a different diagnosis.  But no matter how much "extra" work is done, if it's _*related *_to the original procedure you should not bill an E&M.  

Zaida, CPC


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## jharrell (Sep 25, 2008)

zaidaaquino, This what I always say too if it is related anyway to the procedure and you did not do another procedure then it is global. 

But I have one question, why do you find that to use -24 that you have to have a different diagnosis? I have tried to find it but can't.

Jessica Harrell, CPC


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## zaidaaquino (Sep 25, 2008)

Well, if you are going to use -24 modifier, you need to show that the E&M is *unrelated *to the procedure that has the global period.  How would you show it's unrelated if you use the same diagnosis or if you use one that is related to the procedure?  Of course, your documentation must show the E&M is unrelated.  I found some great examples in a Medicare manual called Primary Care Training Manual dated 7/2/08, pages 20, 21.  (Go to www.trailblazerhealth.com)  I think you may find it useful.  Hope this helps... 

Zaida


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## FTessaBartels (Sep 25, 2008)

*The visit is Global*

Lisa,
To answer your first question ... the visit IS global to the surgery UNLESS the reason for the visit is completely unrelated. (He might have ANOTHER lesion on the same part of the body ... DX might be the same, but it's still unrelated to the lesion that was removed.)

By the way, lesion removal (even melanoma) has only a 10-day global (unless he did a tissue transfer CPT 14000-14300, then it's 90 days).

F Tessa Bartels, CPC, CPC-E/M


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## Ltoth (Sep 26, 2008)

Thank you to all for your help and expertise.  

It is greatly appreciated.

Lisa


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