Wiki What Modifier

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NESmith

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Please help. What if any modifier can be used in this situation.
Inpatient Medicare initial 99223 by Dr. A 10/2/11 for occlusion and documentation clearly states decision for surgery and it was scheduled, so a 57 modifier was added. Dr. B (same specialty) did the surgery 10/3/11(90 day global). Now here's the question; additional diagnostic tests were run and they called Dr. A back in on the morning of the 10/3/11 for Cholecystitis. What modifier could be used to get Dr. A paid for 10/3/11 because decision for surgery was made the day before and he did not do the gallbladder surg, they decided to wait. Would a 24 modifier work even though the surgery was scheduled but not yet performed by Dr. B? Thanks for your help as always
 
Seems adding modifier 24 to the inpatient follow-up E&M should be fine.... Don't forget to indicate in the note surgery was postponed due to this complication (cholecystitis), and use the appropriate ICD-9. :)
 
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Thank You for your quick response but i have one question. The original surgery was not postponed. The Leg/Occlusion surgery was done but after Dr. A saw the patient for chole which they did not do because of the other surgery done by Dr. B. I hope I am not confusing you.
 
NESmith said:
Thank You for your quick response but i have one question. The original surgery was not postponed. The Leg/Occlusion surgery was done but after Dr. A saw the patient for chole which they did not do because of the other surgery done by Dr. B. I hope I am not confusing you.
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I would think just using the 24 modifier on the E/M visit by Dr A for the evaluation of the cholecystitis. There will be a different diagnosis code than what the surgery was being done for so hopefully that will clarify the claim.
 
Thank You once again for your response but I have one more question. The description for the 24 modifier states: Unrelated Evaluation and Management Service by the Same Physician During a Postoperative Period but would this still be appropriate since the procedure has not been done and the patient would not be in postoperative period or would it be correct because it would be considered in the Global on the 90 day procedure? i only want to do what is correct.
 
NESmith said:
Thank You once again for your response but I have one more question. The description for the 24 modifier states: Unrelated Evaluation and Management Service by the Same Physician During a Postoperative Period but would this still be appropriate since the procedure has not been done and the patient would not be in postoperative period or would it be correct because it would be considered in the Global on the 90 day procedure? i only want to do what is correct.
Click to expand...

Modifier 24 is appropriate, because the additional E/M service (for cholecystitis) on 10/3 is unrelated to the surgery that was done earlier that morning. Use of the modifier 24, along with the different diagnosis, will support this info on the claim.

Hope this helps clarify! :)
 
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