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On Jan. 14, coders and billers gained insight into proper use of novel HCPCS Level II modifier FT Unrelated evaluation and management (e/m) visit during a postoperative period, or on the same day as a procedure or another e/m visit. (report when an e/m visit is furnished within the global period but is unrelated, or […]
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Brush up on modifier 24 guidelines to ensure payment for postsurgical unrelated E/M services. Standard postoperative care, including related evaluation and management (E/M), is not separately reportable, but an unrelated E/M service during the postsurgical period may be. To alert the payer that an E/M service provided during the global period is not related to […]
The post Modifier 24: Determine How Your Payer Defines “Unrelated” appeared first on AAPC Knowledge Center.
Now day after (01-29-19) provider billed 99232-24-57 as they are seeing the member in post-op but also made same day decision for another 90-day procedure (61510-58).
How should the 01-28-19 DOS be billed as it is the day prior to decision of the major surgery and provider is indicating unrelated and decision was made the next day/same day 01-29-19?
01-28-19 99232-24 denied because the visit was billed by the same provider within the 61510’s pre-operative period.
01-29-19 99232-24-57
01-29-19 61510-58
Typical post-operative care, including related evaluation and management is not separately reportable; but, an unrelated evaluation and management service during a postoperative period may be. According to the Centers for Medicare and Medicaid Services (CMS), an E/M service provided during the global period of a procedure is unrelated if: • The E/M service is for […]
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4 m/o patient with dx of Hirschprungs disease (Q43.1) s/p surgery on 10/9/17 for complete proctectomy w/ pull through and anastomosis (45120), returned to hospital on 10/26/17 with dx of enterocolitis (K52.9). The patient is still in 30 day Medicaid global at this time. Would the hospital visits related to the 10/26/17 admission be considered related to the surgery performed on 10/9 or unrelated? The enterocolitis is certainly a complication related to the initial diagnosis as pts with Hirschprungs disease frequently do have enterocolitis but nothing in the notes indicate that the enterocolitis is a complication of the procedure itself. I am torn between making the visits post-op visits and no charge vs. whether it would be appropriate to bill these hospital visits with a 24 modifier as unrelated to the original procedure. According to SC Medicaid manual, Complications or services rendered for a diagnostic reason unrelated to the surgery may be billed with a separate examination code if the primary diagnosis reflects a different reason for the service. To report postoperative visits unrelated to surgery, submit the visit code(s) with modifier 24 or 25. The medical record must substantiate that a visit(s) was justified outside of the surgical package limitation.
Any insight would be appreciated!
Samantha