by Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content
October 9th, 2014
When a patient is seen during a global (postoperative) period for something unrelated to the surgery for which the global period applies, modifier -24 is appended to the evaluation and management (EM) service.
The insurance may deny payment for the EM service; however, if the notes for that service clearly show care provided for something other than postoperative care from the procedure, simply appealing the denial with a copy of the medical note should be sufficient to obtain reimbursement from the insurance company.
Example: The patient presents today with tonsillitis postoperative day three for tympanostomy with ventilation tube placement (69433). An evaluation and management (EM) service Physical examination revealed acute tonsillitis and sinus infection and antibiotics were started. Patient will follow-up in one week.
There is a 10-day global period for the 69433 and the patient is seen on day three (3/10) for something 'unrelated' to the surgery (acute tonsillitis). If the EM service was related to the tympanostomy, then there would be no charge and the service would be billed 99024. However, because the two services are unrelated, the provider can be paid for the EM service by appending modifier -24 to the EM service and reporting the proper diagnosis code that is unrelated to the surgery (acute tonsillitis ICD-9 code 463).
Example: 99213-24 assigned to 463.