Wiki help help help -modifer 24

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DISAGREEMENT HERE- hELP

Example
Patient has surgery with doctor A -(90 day global,) patients comes back week later , sees another doctor in same pratice doctor B for an unrelated reason from the surgery,
modifer states 24 to be use by same physcian, so what do I do
One coder states use modifer 24 m, i say no, not the same physcian, , someone else toldd me to send med records with a letter of appeal stating diiferent doctor during post op and stating unrelated , who is right and who is wrong

help help help -thanks
 
"Same physician" means if Dr. A and Dr. B are in the same practice, billing under same tax ID then the use of modifier -24 would be appropriate.
 
only if they are the same specialty. we don't use modifier 24 if the patient is being by a doctor of the same practice under a different specialty.
 
Taxonomy Codes

Hey Jeremy - Based on your question and follow up information, I would have to assume that the physicians are listed under different taxonomy numbers? If so, there should not be an issue, the claim should be submitted without 24 modifer.

Has the claim been submitted at all? If so, what was the rejection reason? Coding is not always about who is right and who is wrong. A lot has to do with payer policies and processes. What works for insurer A, may not work with insurer B. I will state that it is imperative that the primary diagnosis represent the condition the pateint was recently seen for and not a diagnosis "brought forward" in an EMR.

Thanks, Karen Gallagher, CPC, COSC
 
24 is appropriate because both doctors are under the same tax id and practice. modifier 55 is only used when your patient has surgery, but the post op care is handled by a doctor outside the practice.
 
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