Wiki Coding out of Global Period

[LLRodgers]

Can anyone help me to understand how to code the following:

I have a patient who came in for a follow up after ORIF of right shoulder but also has a new complaint regarding the left shoulder. The patient is out of the Global Period.

Do I code the new complaint and then V54.89 - Aftercare and then the E/M Code? Not sure if I need to use a modifier.

Any help some one can give me is very much appreciated.

Thank you,

Linda rodgersl@acmh.org

 

[deborahcook4040]

I would leave off the post op codes entirely, and just code the established patient visit for the L Shoulder with a 24 modifier. You're going to have to submit documentation anyway, since the codes will all pertain to shoulders. The ins co will have no way of knowing you're talking about the OTHER shoulder until they read the note.

 

[amyjph]

When you have this situation, you must separate out what was done/documented for the new c/o the LT shoulder problem. Using that, you can code an E&M w/ a 24 modifier depending on your documentation. I also add the dx code that pertains to what was done for the operative shoulder but it can't count towards your calculation for the E&M level. This is a very common occurence in our practice. Sometimes the patient will have multiple visits with different providers of different specialites for totally separate dx's on the same DOS.