Pediatric Coding Alert

Question: Our provider saw a teenaged patient for a follow-up visit a week after removing a benign wart using cryosurgery. During the visit, the patient mentioned recent stomach discomfort and pain during urination. The pediatrician diagnosed a urinary tract infection (UTI). The follow-up visit fell within the procedure’s 10-day global period. Is this a situation that warrants use of modifier 25?

Pennsylvania Subscriber

Answer: No, but you’re close. The procedure you mention typically is reported with 17000 (Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion), which represents a procedure that has a 10-day global period. In the situation you described, you would append modifier 24 (Unrelated evaluation and management service by the same physician or other qualified health care professional during a postoperative period) because the follow-up that uncovered the UTI fell within those 10 days.

Modifier 24 is similar to modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service), but as you can see from the descriptor, it’s for use on the same day as the procedure when the provider performs an evaluation and management (E/M) service that’s unrelated to the procedure. The E/M service occurred during the follow-up in the scenario you described, and therefore modifier 24 is the more appropriate choice.

Also, modifier 24 will need to be on the claim to indicate the E/M was not part of the procedure’s follow-up. You’ll also need to list the UTI, not the wart removal, as the diagnosis for encounter to indicate it was not related to the wart.

Remember: All payers require that detailed documentation accompany modifier 24. The provider needs to explain why they performed the unrelated E/M service during the global period and what made it distinct and separate from the procedure.