Pulmonology Coding Alert

Question: A patient was admitted for a thoracotomy performed by the thoracic surgeon. He underwent a bronchoscopy by the pulmonologist while under anesthesia. A hospital visitwas performed by the pulmonologist the following day. Should I use a modifier to describe these services? Which one should I choose? 

Virginia Subscriber

Answer: No, you don’t need a modifier in the given case.You performed a bronchoscopy, which has a 0-day global period, meaning the payment includes all the pre-, intra- and postprocedural care provided on the same date as the bronchoscopy. You can separately report the next-day subsequent hospital service (99231-99233) as it was performed on a different calendar date (the next day). Your pulmonologist would not need a modifier since the service doesn’t bundle into the bronchoscopy global period or surgeon’s global period.

A global period is a defined time period (0, 10, or 90 days) specific to each procedure or service and encompasses all pre-, intra- and postprocedure care. You have to bear in mind the procedure’s global period when an E/M service, such as a consult, is performed in combination with a procedure. You can report care for problems that are unrelated to the procedure during a global period provided it is separate and identifiable from the reason for the procedure. For example, you can separately report hospital care involving asthma management for a patient who has received a bronchoscopy for dyspnea.

You may use one of three modifiers to report a separately identifiable E/M service from a procedure. If the E/M service was provided on the same day of a minor procedure (with a 0- or 10-day global period), you will use modifier 25 (Significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service).

If the patient received an E/M service on the same day of or a day before a major surgical procedure (with a 90-day global period) and it resulted in the decision for surgery, you may use modifier 57 (Decision for surgery) along with the E/M to allow for separate payment.

Note: If the decision making for surgery was not a part of the E/M on the day before or day of surgery, you cannot report the visitseparately, as this E/M provided is part of the pre-procedure care.

You may append Modifier 24 (Unrelated evaluation and management service by the same physician during a postoperative period) to an unrelated E/M service when reported on any postprocedure day during a 10- or 90-day global period.