08/09/2018

Correct Coding for a Fractured Toe & Infection on the Same Foot Prior to Global Period

A patient comes in for a fractured toe 99203 25 73630 RT 28510 ALL PAID-Then patient comes in for an infection on same foot-L03.031 before global period 99213 79-- denied. Should this be paid? Can copayment be charged?

The visit for the infection should be billed with a 24 Modifier not 79. 

Modifier 24 is defined as an unrelated evaluation and management service by the same physician or other qualified health care professional during a post-operative period.

Appropriate Use

• Use Modifier 24 with the appropriate level of E/M service.
• Use Modifier 24 on an E/M when:
• An unrelated E/M service is performed beginning the day after the procedure, by the same physician, during the 10 or 90-day post-operative period.
• Documentation indicates the service was exclusively for treatment of the underlying condition and not for post-operative care.
• Unrelated critical care performed by the same physician during the post-operative period.
• The same diagnosis as the original procedure could be used for the new E/M if the problem occurs at a different anatomical site.

Inappropriate Use

Do not use Modifier 24 when:

• The E/M is for a surgical complication or infection. This treatment is part of the surgery package.
• The service is removal of sutures or other wound treatment. This treatment is part of the surgery package.
• The surgeon admits a patient to a skilled nursing facility for a condition related to the surgery.
• The medical record documentation clearly indicates the E/M is related to the surgery.
• Outside of the post-op period of a procedure.
• Services are rendered on the same day as the procedure
• Reporting exams performed for routine postoperative care.
• Reporting surgical procedures, labs, x-rays, or supply codes.

Modifier 79 is appended to a procedure code to indicate that the service is an unrelated procedure that was performed by the same physician during a post-operative period.

A copayment can only be charged if the insurances deems the copayment as the patient responsibility.