# E/M With Modifier 24 During Global Period



## MBA101 (Mar 14, 2008)

I'm totally confused.  Please help!  My understanding on modifier 24 is you use this when a visit is unrelated to the global period.  I understand that.  I just received an email form Part B insider Wire stating modifier 24 can be used if the pt is being seen during the global for an e/m that is due to a complication from the surgery.  Is this correct.  Examples:

Ms. Smith had a tonsillectomy on 3/1/08 and reports to hospital on 3/20 with a post tonsillectomy hemorrhage.  Can you add a 24 to the e/m or is it considered global?

Mr. Jones is admitted to hospital for surgery on 2/15/08 for pharyngesophagel repair and skin split grafts. Pt has cancer. Dx for repair is 874.4 and dx for skin split is 173.3.  Pt stays in hospital for undetermined amount of time. Hospital susbsequent visits dx is 478.29. Can I add a modifier 24 to the subsequent hosptial visits or is it considered global?

If you could give me an example of when a 24 can be added due to complications.

Thank you
Melanie

Thank you.

Thank you


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## mbort (Mar 14, 2008)

That is true, the modifier 24 can be used on an E/M when the patient is seen within the global period for a complication.

Mr. Smith has a total hip arthroplasty, returns to the ER 5 days later for a dislocation.  The 24 modifier would be used on the E/M code (same physician group of course).


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## MBA101 (Mar 14, 2008)

Thank you for your response.  It's greatly appreciated.   

Melanie


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## mmelcam (Mar 15, 2008)

If this was a complication to the surgery how is this an unrelated visit? I thought any complications to surgery were included in the global period.


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## Lisa Bledsoe (Mar 17, 2008)

I'm with Melissa...how is a complication not related to the surgery?


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## jharrell (Mar 20, 2008)

I agree with Melissa and Lisa as well. We have had this battle whithin our company. 

They would never have the complication it they didn't have the surgery. So I think that it is related to the surgery, "so if you look at it that way" then you can't use a -24 on the e/m if it is related. I have been to a couple of semiars one being Medicare and they both say that if the follow up is related to the surgery then you can't use the -24 and if you can't use a -24 then you shouldn't be able to charge an e/m. I have added below a section in the Medicare IOM from the Global Surgical Package section. Chapter 12 section 40 

Complications Following Surgery - All additional medical or surgical services
required of the surgeon during the postoperative period of the surgery because of complications which do not require additional trips to the operating room;

Please if anyone has anymore info I would like to know, I think this maybe a problem with a lot of people.

Jessica Harrell, CPC


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## tadavis (Mar 20, 2008)

I think any complication that requires the use of rvu's can be billed with mod 24. Normally you should not expect adnormal complication after  simple surgery,low grade temp, light bleeding, some pain, etc,is normal.  But during post-op the pt should be getting better within the that global period unless there is something negligent going on within the pt or within the
procedure.  Besides  if you think it is billable- bill it.  If it is denied and the Dr. think his/her work was outside of the normal postop complications, appeal the claim.  The insurance carriers will most likely deny anything within the global period the first time but stand your grounds and appeal it, Your physician may have to write a letter or something but You may be surprise of the outcome. 

Toni


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## racheleporterwilliams (Mar 25, 2008)

E&M-24 is used for unrelated problems during the global period 
99024 is used for reasons related to the original procedure 



MBA101 said:


> I'm totally confused.  Please help!  My understanding on modifier 24 is you use this when a visit is unrelated to the global period.  I understand that.  I just received an email form Part B insider Wire stating modifier 24 can be used if the pt is being seen during the global for an e/m that is due to a complication from the surgery.  Is this correct.  Examples:
> 
> Ms. Smith had a tonsillectomy on 3/1/08 and reports to hospital on 3/20 with a post tonsillectomy hemorrhage.  Can you add a 24 to the e/m or is it considered global?
> 
> ...


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