Wiki Mod 24 use follow up with new problem

[patt1018]

Hello

I was wondering if anyone could provide some feedback on the use of modifier 24. A patient had surgery on his left elbow and was seen in the office again within the global period for follow up. The provider submitted records and in the record it states the patient was there post-op but the patient had a complaint about his right hand/elbow and felt that he may need surgery on this side also because he didn't realize how much pain he was in until after the surgery to the left side. My colleague disagrees that the modifier 24 is appropriate and we should not pay the claim based on the global period. However, I believe the modifier 24 is appropriate for this visit even though it was a f/up to the surgery because it was discussed that he had a "new" problem.

Any feedback is appreciated.
Thanks

 

[csperoni]

Modifier -24 is definitely appropriate in this case since it is a problem unrelated to the surgery.
I will note the level should be determined by looking only at the documentation regarding the right hand/elbow. For example, if the provider orders testing of left elbow or discusses pathology from the left elbow surgery, that does not get counted in leveling.
An E/M with -24 is justified and should be paid, based on the level related to the right hand/elbow.

 

[patt1018]

Thank you for your response!