Urology Coding Alert

Question: A patient came to our office for a follow-up visit during his surgery’s global period. He brought a new problem to the doctor’s attention during the visit. Can we charge for the office visit and add a 24 modifier?

Arizona Subscriber

Answer: Yes, you should be able to submit the appropriate level of E/M service with modifier 24 (Unrelated evaluation and management service by the same physician or other qualified health care professional during a postoperative period) if the situation meets the modifier’s criteria.

You can append modifier 24 to an E/M code when an unrelated E/M service is performed beginning the day after the procedure, by the same physician, during the 10 or 90-day post-operative period, and documentation indicates the service was exclusively for treatment of the underlying condition and not for post-operative care.

Note: The same diagnosis as the original procedure could be used for the new E/M if the problem occurs at a different anatomical site.

Extra tip: Do not use modifier 24 for these scenarios:

• When the E/M is for a surgical complication or infection (included in the surgery package)
• The service is removal of sutures or other wound treatment (included in the surgery package)
• The surgeon admits a patient to a skilled nursing facility for a condition related to the surgery
• The medical record documentation clearly indicates the E/M is related to the surgery.