Thursday, May 26, 2011

Modifiers in Postoperative Periods

Introduction


Documenting the events of a patient visit is not always the simplest and most straightforward of processes. Many variables affect which information must be included in order to report a procedure or service accurately. Global periods are one of those variables. A global period is the amount of time before, during, and after a surgical procedure that covers the typical patient care for that particular procedure. When a provider performs a new procedure or service on a patient who is within the global period of a previous procedure, the new procedure must be distinguished by using a modifier.


Modifiers 24, 58, 78, and 79 were created specifically to handle the various postoperative scenarios that often occur. When it comes to claims processing, these modifiers are well-known trouble spots that frequently generate reviews or denials. Practices that accurately apply modifiers 24, 58, 78, and 79 will see a decrease in claims denials and an increase in reimbursement.


Global Surgical Package

Any surgical procedure listed in the CPT® Manual (10021-69990) is subject to global periods under the Medicare Physician Fee Schedule. In the Medicare Physician Fee Schedule Database (MPFSDB), each procedure is assigned a global period status: 000, 010, 090, MMM, XXX, YYY, or ZZZ. The three global period statuses coders must pay attention to are 000, 010, and 090 for minor and major surgical procedures.

Note: To access the MPFSDB, go to: http://www.cms.hhs.gov/PhysicianFeeSched/01_overview.asp

Minor surgical procedures include either a zero or 10-day postoperative period, starting the day of the surgical procedure. Major surgical procedures include a 90-day postoperative period, starting either the day before or the day of the surgical procedure. When patient care falls within either the 10-day or 90-day global period, new services must be documented with a postoperative modifier.

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