Wiki Do you use a Modifier 24 for a PCP visit within the Global Period?

[Carroll1220]

Good evening!

If anyone could please clarify this for me, it would be appreciated. Back in September, I posted a question if you would use a Modifier 55 when a patient who had gallbladder surgery in June came in for a visit in August with the PCP within the Global Period of the surgery. The answer I received from this forum was very helpful and Debra explained we would not use it.

For some reason, Medicare didn't receive the claim we submitted so I had to re-submit the claim. When doing so, the question occurred to me if you would bill a modifier 24 with it? If anyone could please give advice as to whether a modifier 24 would be appropriate for this situation, or no modifier at all, it would be appreciated!

Thank you!
Noelle

 

[JesseL]

Good evening!

If anyone could please clarify this for me, it would be appreciated. Back in September, I posted a question if you would use a Modifier 55 when a patient who had gallbladder surgery in June came in for a visit in August with the PCP within the Global Period of the surgery. The answer I received from this forum was very helpful and Debra explained we would not use it.

For some reason, Medicare didn't receive the claim we submitted so I had to re-submit the claim. When doing so, the question occurred to me if you would bill a modifier 24 with it? If anyone could please give advice as to whether a modifier 24 would be appropriate for this situation, or no modifier at all, it would be appreciated!

Thank you!
Noelle

You would use transitional care codes I believe. Assuming the surgery was done in the hospital. The surgeon would have to authorized this I think, otherwise you can bill for the PCP visit. The patient should follow up with the surgeon. This is only if the patient came to the PCP to follow up on the surgery. If the patient came for something else, I don't think a modifier is needed. Modifier 24 is only for the on that performed the surgery.

http://medicaleconomics.modernmedic...9495/making-sense-new-transitional-care-codes

 

[mitchellde]

If the PCP is following the patient for post operative issues, then his must be done with a transfer of care from the surgeon and billed as the surgical code with the 55 modifier, not billed as transitional care. If there is no transfer of care from the surgeon then the visit is either not billable or is billed to the patient, only the surgeon can direct who treats the patient for post op issues if it is yo be billable. If the visit is for issues not related to post op, the PCP bills a visit level with no modifier, the surgeon would bill those visits with the 24 modifier. As far as transitional care goes, you should read the information in the CPT book regarding usage and application.

 

[Carroll1220]

Thank you both so much for your input! That really clarifies this for me. The reason for the visit was abdominal pain so because I don't think it was directly related to the surgery and that there was no transfer of care, I will just code for the visit without a modifier. I really appreciate your help!

Thanks again!
Noelle