Orthopedic Coding Alert

Test your coding knowledge.  Determine how you would code this situation before looking at the box below for the answer.
Question: Which modifier should I attach to the E/M code if, during the postoperative period, the patient reports to the office with a new problem unrelated to the original procedure and, as a result, a minor in-office procedure is performed?

Ohio Subscriber


Answer: Three modifiers should be appended in this case because there are several things the carrier must know. First, this was not a post-op visit and, second, the E/M service was separate from the procedure performed. You also need to indicate that the minor procedure was not related to the previously performed surgical procedure. Report the CPT code for the minor procedure with modifier -79 (unrelated procedure or service by the same physician during the postoperative period) and also for the E/M using both modifiers -24 and -25. The -24 modifier tells the carrier that the E/M visit was an unrelated evaluation and management service by the same physician during a postoperative period, and was not related to the original surgery. The -25 modifier tells the carrier that the E/M service was a significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service.