Wiki Modifier 58 on E&M Code?

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jackjones62

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To all E&M gurus out there, I have a patient that had a superficial parotidectomy in Jan. 2015, pathology (+) for cystadenocarcinoma, low grade; pt. is 83 and chose palliative treatment; returned the end of March 2015 due to recurrence and new mass; our physician charged and extended follow up 99214 and of course it was denied as being part of the global; I am in a quandary as our physician spend a extended period of time with patient and wife regarding treatment; this is a new mass in the same post-operative field, it is related, therefore, modifier 24 is not applicable...I am pushing the boundary of Modifier 58's definition with regards to "Procedure or Service"; can 58 be applied to an E&M code???? as it was a service that was provided?

Any thoughts.......

Jennifer
CT ENT
 
jackjones62 said:
To all E&M gurus out there, I have a patient that had a superficial parotidectomy in Jan. 2015, pathology (+) for cystadenocarcinoma, low grade; pt. is 83 and chose palliative treatment; returned the end of March 2015 due to recurrence and new mass; our physician charged and extended follow up 99214 and of course it was denied as being part of the global; I am in a quandary as our physician spend a extended period of time with patient and wife regarding treatment; this is a new mass in the same post-operative field, it is related, therefore, modifier 24 is not applicable...I am pushing the boundary of Modifier 58's definition with regards to "Procedure or Service"; can 58 be applied to an E&M code???? as it was a service that was provided?

Any thoughts.......

Jennifer
CT ENT
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Mod 58 would be for any procedures that were performed in the postop. For an E/M service, you need mod 24. Even though the diagnosis is the same, the new mass goes beyond the "typical postop care". Since the diagnosis is the same, you may have to appeal, but your doc is definitely justified in billing for the E/M service related to the new mass.

HTH!
 
I agree with Meagan, a new mass, even in the same location, would no longer fall under the postop care. Use the 24 and appeal if you have to. Payment is deserved.

Also, there are only 3 E/M modifiers - 24, 25, and 57. All other modifiers are for procedures.
 
Thanks everyone, you know when you know the answer but because of unusual circumstances you doubt yourself and just need that round table discussion to reaffirm your decision...........

Thanks again.....

Jennifer
CT ENT
 
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