Wiki Please help a biller settle a dispute with surgeon!! - E&M modifiers

[arickord23]

I am having a debate with my surgeon over appropriate E&M modifiers and I need some tie breakers!!

A patient was seen today for follow up to RT shoulder pain. (No sx, no fracture, has cortisone injection in February) Today's visit we recommended MRI to RT shoulder to evaluate continued pain after PT and injection.
During this visit, he states that he stubbed his toe a few days ago.
Xrays of the RIGHT foot taken in the office today demonstrate a nondisplaced oblique fracture through the diaphysis of the proximal phalanx of the 5th toe.

We are billing the E&M for the shoulder: 99214
foot xray: 73630 &
fracture care for the toe: 28510

We are "debating" the appropriate E&M modifiers. 24? 25? Both??

Please help!!

Thanks!
Andrea

 

[CoumbaSam]

I will go with Mod 25

 

[CoumbaSam]

Actually you can use both 25 and 24

 

[jdibble]

This question was answered under General Discussion forum.

Use 25 only in this case. The 24 modifier is used when an E/M for a different reason takes place during the global period of a procedure and is performed by the same physician. From your scenario, there was no surgery with a global period performed, so you would not use the 24 modifier.

 

[bedforak1]

Is the patient in a global for another procedure? If not, you would only need modifier 25 appended to the E/M.

 

[OCD_coder]

Folks, the 28510 has a 90 day global period and a modifier 57 is needed on the E&M for this code to pay. Some carriers want a modifier 25 due to the x-ray, so check with the carrier. So both may be needed on the claim/E&M.

I have no clear understanding why a modifier 24 is needed as what procedure is the patient under a global period for? If they were seen in Feb for an injection they probably are not in a global period any longer.

Note: the modifier 57 does not trump and cover care for modifier 25.

http://www.cms.gov/Outreach-and-Edu...oducts/downloads/GloballSurgery-ICN907166.pdf

 

[mzkandyd]

I agree with OCD_coder. There is no reason to use modifier 24 because the patient isn't within a global period or s/p.