Anesthesia Coding Alert

Question: We have a pain patient who was seen for an injection with fluoroscopic guidance (CPT 64622, Destruction by neurolytic agent, paravertebral facet joint nerve; lumbar or sacral, single level; and 76005-26, Fluoroscopic guidance, -professional component). A week later, this patient was seen for an E/M exam related to the procedure. Medicare has denied the claim for the E/M visit, stating that the exam falls within the 10-day global period for the injection procedure. Is there any way we can be reimbursed for the E/M service? New York Subscriber Answer: According to most local medical review policies (LMRPs), 64622 has a 10-day global period because Medicare carriers consider it a minor surgical procedure. The global package for procedures with a 10-day postoperative period consists of three stages:   Preoperative visits beginning with the day of surgery Intraoperative services that are normally a usual and necessary part of a surgical procedure Postoperative visits related to recovery from the surgery in the 10 days immediately following the surgery. Because the physician performed the E/M exam within the 10-day postoperative period and it is related to the surgery, it is not separately reimbursable. If the patient presented with symptoms that the doctor could identify as separate or unrelated to the surgery, the carrier may cover the E/M exam. Had this been the situation, you could append the appropriate E/M code with modifier -24 (Unrelated evaluation and management service by the same physician during a postoperative period).