Wiki E/M Modifier for Payment During Global

[graceroni13]

One doctor evaluated and treated the patient with a closed reduction of an elbow. After the surgery it was determined that the injury was more complicated and the patient would need further evaluation and surgery. Patient was referred to a different physician within the same group practice during the post op period who specializes in these more complex elbow injuries. Patient was evaluated in the office and decision was made for further surgery on the elbow(again, during the post op period). He decided to do a radial head replacement, lateral collateral ligament repair, anterior capsulodesis, and ORIF of anteromedial coronoid fracture.

How do you code for the E/M for the second doctor since he made the decision for surgery on the same body part?

 

[jdibble]

Is the other doctor listed under a different specialty than the first doctor - like a hand specialist - or he does he just do more complicated surgeries? If he is not listed as a specialist, then he cannot bill for the E/M as it is considered in the global period. He can bill for the surgeries with the appropriate modifer - such as 58 for staged procedure or 78 for unplanned return to the OR.

Hope that helps!

 

[graceroni13]

He works in the same office as the other doctor, but is a hand/upper extremity specialist. Everything seemed like it went okay! i ended up just doing the E/M with a mod 24 thank you!