Pulmonology Coding Alert

Question: While under anesthesia, a patient admitted for a thoracotomy was administered a bronchoscopy. A consult was performed the following day. Is there a modifier to describe these services?

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Answer: No modifier is required. A bronchoscopy has a 0-day global period. Payment is made for all of the pre-, intra- and postprocedure care provided on the same date as the bronchoscopy. Because the consult was performed on a different calendar date (the next day), it is separately reportable.
 
When an E/M service, e.g., a consult, is performed in conjunction with a procedure, it is important to identify the procedures global period. A global period is a period of time (0, 10, or 90 days) assigned to a procedure or service that includes all preprocedure, intraprocedure and postprocedure care. Care for problems that are not related to the procedure can be reported during a global period as long as it is separate and identifiable from the reason for the procedure: e.g., subsequent hospital care involving asthma management is a separately reportable service for a patient who received a bronchoscopy for dyspnea. 
 
Three modifiers are used to differentiate a separately identifiable E/M service from a procedure. Modifier -25 (significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service) is appended to an E/M service when reported on the same day that a minor procedure (with a 0- or 10-day global period) was performed. If an E/M service was provided on the day of or day before a major surgical procedure (with a 90-day global period) which resulted in the decision for surgery, modifier -57 (decision for surgery) is appended to the E/M to allow for separate payment. (If the decision for surgery is not made on the day before or day of surgery, the E/M provided is part of the pre-procedure care and is not separately reportable.) Modifier -24 (unrelated evaluation and management service by the same physician during a postoperative period) is appended to an E/M service when reported on any postprocedure day during a 10- or 90-day global. Assignment of global period days can be found within Addendum B of the Health and Human Services section of the Federal Register. This can be accessed at www.gpo.gov/su_docs/aces/aces140.html. 

-- Answers to You Be The Coder and Reader Questions provided by Melissa Kersnick, CPC, Stoler and Horowitz, Prospect, Ky; Cynthia L. Sommma, CPC, Nassau, Queens Pulmonary, Hyde Park, N.Y; and Carol Pohlig RN, CPC, a reimbursement analyst for the office of clinical documentation at the University of Pennsylvania.