Wiki Office visit for post-op and consult same day

[2believe]

Patient came in for a post-op visit for a Status post right shoulder replacement for a proximal humerus fracture. (02-08-23). When the patient came in and the doctor did an x-ray the shoulder showed dislocation of the shoulder. The patient was sent to the hospital. The doctor also, did a consult once he got to the hospital and made the decision to do surgery the same day. Can I bill a post -op 99024 with the x-ray in the office? and a consult 99222-57 with decision for surgery? Or do I just bill the Consult with the 57?

 

[thomas7331]

CPT code 99024 isn't actually 'billed' since that's a no charge visit. But yes, you can code for that and the x-ray in the office - x-rays are excluded from the global package. For the hospital visit, you'd need both modifier 24 and 57 since you're in the global period of the previous surgery and also making a decision for a new surgery. Of course, the documentation would need to support both of those modifiers. If the new surgery is for treatment of a complication related to the previous surgery, then you may not be able to support the modifier 24 here since CMS considers treatment of complications to be a part of the post-operative care.