Thursday, November 17, 2011

24 Modifier usage with related diagnosis and unrelated DX

24 Modifier

Unrelated evaluation and managem
ent service by the same
physician during a postoperative period

Use modifier 24 when an E/M service is performed during a postoperative follow-up period for reasons unrelated to the original minor or major procedure.



The physician must indicate that the services billed are unrelated and not part of the postoperative diagnoses.

Examples of Related Diagnoses

Example 1: A surgical claim was billed with ICD-9-CM code 1622 (malignant neoplasm of trachea, bronchus and lung; main bronchus). Ten days later, a claim (for dates of service 10 days after a 90-day global surgery) is submitted by the
same physician for an office visit and the ICD-9-CM used on the claim is
486 (pneumonia, organism unspecified).

This E/M service would be considered part of the global period and would
not be payable.

Example 2: A surgical claim was billed with ICD-9-CM code 59653 (paralysis of the bladder). Eighty days later, a claim (for dates of service 80 days after a 90-
day global surgery) is submitted by the same physician for an office visit
and the ICD-9-CM code used on the claim was 78900 (abdominal pain,
unspecified site).

This E/M service would be considered part of the global period and would
not be payable.



Examples of Unrelated Diagnoses
Example 1: A surgical claim is billed with ICD-9-CM code 38421 (central perforation of tympanic membrane – ear drum). Two months later (during the 90-day global period), an E/M service is billed with ICD-9-CM code 3804
(impacted cerumen – ear wax).

This E/M service would be considered unrelated and would be payable.
Example 2: A surgical claim is billed with two 90-day global surgical codes for date of service July 9. The ICD-9-CM diagnoses submitted on the claim are 5533
(diaphragmatic hernia) and 56210 (diverticulosis of colon). An E/M service
is performed and billed for date of service July 26. The ICD-9-CM codes
submitted are 7872 (dysphagia – difficulty in swallowing), 7015 (other
granulation tissue) and 78079 (other malaise and fatigue).

This E/M service would be considered unrelated and would be payable.
If the E/M service is unrelated to the postoperative follow-up period,
modifier 24 is appropriate.

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