Wiki Scheduling 2nd surgery during postop

[sjmccarl52]

Scenario: Patient comes in for first visit and is diagnosed with bilateral carpal tunnel syndrome. She schedules the first surgery. At postop visit she schedules other hand and physician charges either level 3 or level 4 (2 different physicians) along with postop n/c visit. We are getting the level denied even though I am using two modifiers.....24 and 57. Can we really charge a level when pt was diagnosed as bilateral at first visit? The only thing documented for next surgery is that "patient wants to proceed with surgery on right side and we will schedule this for sometime soon. A complete history and physical were placed on the chart." Any thoughts?

 

[michellelgrd]

the decision for surgery on both hands was already made at the first visit right? therefore u cannot bill it again.
she came for a post op visit and scheduled the second surgery? i dont see where it would be payable

the only thing i can think of is to add in the dr notes that though the patient had bilateral carpal tunnel the right was worse than the left and required surgery

on the note for the post op visit i would add that the patient made the decision to go ahead with surgery on the left

its all in how you word it

 

[banderson77]

We do this all the time. You can bill the visit in between the 2 surgeries as long as it is not the day before the second surgery. Should read as followed:

1-10-10 64721 lt
1-15-10 99213 24
1-20-10 64721 79/rt

Of course the dates would be different, but that should work. 57 is only needed if surgery was planned within 24 hours prior to the actual surgery. Hope this helps.

 

[sjmccarl52]

We have done this but Medicare will not pay. They have denied all of them due to patient being in postop days.