Wiki What Modifier is used for OV after procedure in 90 day period?

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kfrycpc

kfrycpc

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Hi all,

I bill for wound care and lately I've been getting denials on OV that occur within the 90 day surgical global period. A lot of the patients come in a couple times a week after they may have had a lesion removed, etc. When I bill their next OV, it gets denied saying it's part of the surgical procedure. Is there a modifier I can use to show the visit was not planned for the procedure and the assessment exceeds the parameters of what is normally inclusive for the procedure? The CPT I usually bill is 99212-99214 for the OV. I looked in the CPT guide and I'm wondering if I should be using modifier 79 "unrelated procedure or service by the same physician during the postoperative period".

Also, if that's the mod to use, can I still append a 59 mod on the dsmr CPT line when there is an additional service that day (usually a 97597 or 11042).

Thanks!
Kellie
 
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Hi Kelly

Use 24, It is used for returning of patient in office for unplanned visit during global period . 78 or 79 is for returning to hospital during global period.

This is was we use to do in my old job and claims got paid with out any issue.

I hope this helps.

Thanks

Vimal Savalia,CPC
 
If the visit is related to the procedure, there should be no charge within the 90days post op period therefore coded 99024-NC but if the visit is for a non related problem then modifier 24 should be appended with a Dx for the new issue:)
I hope this helps.
Abby Akinleye, CPC
 
24 is used for E&M codes only, and 78/79 are used for procedures only. 78/79 are for unplanned procedures during the global and are not restricted to the facility setting any longer. 58 is used for procedure only for planed procedures during global again regardless of setting.
 
Thank u!

Thank you all :) 24 it is!

One more thing, can I still use mod 25 on that line for an additional procedure for that day? And, do I need to use 79 for the next line. For example: the claim would look like:

99213 (24)(25)
97597 (59)(79)

Or is the 24 the only mod I need to use?

Sorry for so many questions...I've only recently started getting these denials.

Thanks again!
 
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