ED Coding and Reimbursement Alert

Question: I received a denial from Medicare for a patient who had two hip dislocation reductions performed about 60 days apart. I used modifier -54 on both, but the second visit keeps getting denied because Medicare states that the physician performed it during the global period for the initial procedure. Are there any other modifiers I should use to justify this work?

Alabama Subscriber

Answer: Instead of appending modifier -54 (Surgical care only), you should consider using modifier -59 (Distinct procedural service) to identify the second reduction as a distinct procedural service. The second reduction is really the result of a different injury that the physician treated during a separate session, so you should report it as such. And you might want to submit the emergency room notes to clarify your position.

Otherwise, the 90-day global period should cover all normal services involved with the billed procedure. You should also double-check with your local payer -- many have different policies on additional services provided during a global period, and knowing what they are will save you time and trouble in the future.