Wiki ER-Consultation

[SSweetland]

This pt was post-op/came into the ER and the ortho did another consult and procedure. Added the 78 modifier to the procedure but wanting to know what can we charge in replace of the consult--99215?? Medicare is denying it because the pt is in a post-op status, already charged a consult prior. Is there any E/M i can charge for the ortho's time with the pt?

 

[dclark7]

If it was a complication from the original procedure Medicare will not pay for the E/M, only the return to the OR. If the problem was not related to the original surgery you need to bill an appropriate E/M code (not a consult code) and add modifiers 24 to signify that the pt is in a global period and this visit is unrelated and 57, decision for surgery. Since you said you added 78 to the procedure code, it sounds like this was related to the original surgery. In which case like I stated above, Medicare will not pay the E/M.