General Surgery Coding Alert

Question:  When our surgeon places a peritoneal dialysis catheter in an open procedure, he always schedules a follow-up office visit to evaluate the wound. Can we charge for this visit, or is it part of the global surgical package? If we charge for it, do we need to use modifier 24?

Texas Subscriber

Answer:  The procedure you describe is 49421 (Insertion of tunneled intraperitoneal catheter for dialysis, open). Because the procedure has zero global days, the follow-up visit is not part of a global surgical package. 

That means you can charge an office visit code for an established patient such as 99212 (Office or other outpatient visit for the evaluation and management of an established patient …) when the patient comes to the office and the surgeon evaluates the surgical site.

You should not use modifier 24 (Unrelated evaluation and management service by the same physician or other qualified health care professional during a postoperative period) with the E/M code. First of all, the E/M service is not unrelated to the surgical procedure, and second of all, there’s not a “postoperative period” for a procedure that has zero global days.