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Medical Billing Tip: Know your payer's policies on billing complication treatment. To ensure payment for E/M services that your physician carries out within the global period of a surgical procedure, you should know the particulars of modifier 24 (Unrelated evaluation and management service by the same physician during a postoperative period). Read on for expert medical billing tip. Let our medical coding and billing experts tell you how to tackle these three modifier 24 myths to make certain that you're submitting clean, successful claims. You Can Never Use Modifier 24 For Compliation-Related Services While you report postoperative services to payers that follow CPT guidelines, you'll require appending modifier 24 to the E/M code in order to show that the service took place during the surgery's global period. Example: In case a patient is going through abdominal surgery and returns to your office with a postoperative wound infection along the suture line, you might be able to collect from private payers for an established patient visit as well as for the physician's treatment of the infection. Our medical coding and billing experts maintain that in case the physician carries out the treatment o the infection in his office, you may be able to file a claim with the help of modifier 24 to those payers following CPT guidelines. Pointer: Complications of surgery can be distinct and billable in certain cases, except the payer is following Medicare rules. Medicare disallows post-operative complications (hematoma, seroma, infection, etc) to be reimbursed except there is a requirement to return to the operating room. At that point, a separate modifier comes into play. There Should Be a New Diagnosis If You Use Modifier 24 Though a different ICD-9 diagnostic code might specify that the E/M service carried out in a global period was not linked to the surgery, you do not have to have different diagnoses to append modifier 24 and to obtain payment for those services. According to medical billing experts, it is not essential that the two services have a dissimilar diagnosis but it should be well specified that the service is carried out to discuss results, prognosis as well as treatment options and that any work done related to the surgery (change bandages, check wound, etc.) is not used to support the level of service billed. You Should Never Use Modifiers 24 and 25 Together You may catch yourself in situations where you require to combine the forces of modifiers 24 and 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) in order to avoid a denial of a claim. To ensure clean medical coding and billing claims, you can use 24 as well as 25 on the same claim, in case you are seeing a patient for an entirely new issue in the post op period, a procedure was carried out that same day, and the E/M code is important and distinctly identifiable from the procedure Medical Billing Tip: You should always use the postoperative modifier (24) first, before you use other modifiers. Most computers sequence their edits, putting the postoperative period edits as the primary edit. Get more medical billing tips like these. Click here to read get access to our monthly Medical Office Billing & Collections Alert newsletter: Your practical adviser for ethically optimizing billing and collections for your medical practice. Read on to perfect your claims and get access to many medical coding and billing alerts tailored especially for your needs: http://www.supercoder.com/articles/articles-alerts/mob/modifier-mythbuster-part-2-learn-the-truth-behind-3-more-common-modifier-24-myths-108520/
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