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?

 

[emcee101]

Since the E/M is for a related problem and both of the physicians are working for the same practice you are restricted to 99024 "Postoperative follow-up visit, normally included in the surgical package, to indicate that an evaluation and management service was performed during a postoperative period for a reason(s) related to the original procedure"

 

[mhstrauss]

I'm going to play devil's advocate here...although I really think I'm just overthinking this.

Medicare's Global Surgery Fact Sheet states that:

? Follow-up visits during the post-operative period
of the surgery that are related to recovery from
the surgery are included.

I don't feel that the situation described above is "related to recovery from the surgery"...which I typically consider incision care, post-op pain management, etc.

Also, CMS lists the following as not included:

? Treatment for the underlying condition or an
added course of treatment which is not part
of normal recovery from surgery;

? If a less extensive procedure
fails, and a more extensive
procedure is required, the second
procedure is payable separately;

? Initial consultation or evaluation of the problem
by the surgeon to determine the need for
major surgeries. This is billed separately using
the modifier -57 (Decision for Surgery). This
visit may be billed separately only for major surgical procedures.


So I guess basically, in my mind, the complication discovered after the initial surgery is a new problem, of which the doc is allowed to bill the initial evaluation. Which would allow for the use of modifier 24 on the E/M service to evaluate the problem, and also allow for billing of the subsequent surgery for the more complicated problem.


Anyone have thoughts on this?



Sorry, here's the link to the fact sheet, if anyone hasn't seen it yet.

http://www.cms.gov/Outreach-and-Edu...oducts/downloads/GloballSurgery-ICN907166.pdf

 

[mhstrauss]

Arghhh...one more question!

The first bullet listed of things not included--treatment for underlying condition--would an E/M service be considered treatment? Or only other services/procedures?

 

[graceroni13]

Thank you so much for your response mhstrauss!!!! So I think I'm gonna charge for the E/M with a -24. The closed reduction that this patient is in global for is for their dislocated elbow.... The surgery that occurred after is for other diagnosis. I'm gonna try it out and i can let you all know what happens?