Guidance For Modifier 24 Usage
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1 March 4, 2016 Guidance For Modifier 24 Usage Modifier 24 (Unrelated Evaluation and Management Service by the Same Physician during a Postoperative Period) has generated more scrutiny lately because of the attention it is receiving from Recovery Auditors and payors. An assignment of modifier 24 will oftentimes trigger a medical record request, so we must be confident when appending the modifier that we are using it appropriately. There are a few important details that need to be known when coding for services during the postoperative period of a surgical procedure and appending modifier 24. First, how many global days were associated with the surgical procedure? For this information, we must turn to the Medicare Fee Schedule Databse (MFSDB). The MFSDB contains information of the postoperative periods that apply to each surgical procedure. Based on the designations in the MFSDB, a surgical procedure may be identified with code "090" indicating a major procedure and "000" or "010", indicating a NAMAS is the leading source of CEU's for maintenance of your credentials- even those hard to find CEU's for CPMA We offer 4 membership levelschoose the one that best suits your needs! Click Here to View NAMAS Membership Levels and Benefits For added convenience, NAMAS accepts PayPal, PayPal Credit, quarterly and monthly payments of membership dues. Click Here to Join Today! NAMAS 1 Day E/M Auditing
2 minor procedure or endoscopy. These codes identify the number of global days assigned to the procedure. There are also designations of "YYY" indicating a carrier-priced code (meaning that most often the carriers determine the number of global days), and "ZZZ" which are used with add-on codes and therefore follow the global day designation for the primary code it is billed with. Secondly, was the encounter unrelated to the surgical procedure for which we are in a global period? For this information, we must know what is included in a global surgical package and whether the provider documentation indicated this evaluation and management visit's distinctness. As the modifier indicates, the evaluation and management service is "unrelated", so we would expect the provider to be clear in his/her documentation on the nature of the visit. Modifier 24 is appropriate to use for: surgical complications that require a trip to the operation room, treatment of wound infections, patient admissions to skilled nursing for a condition related to the surgery, dressing changes, postoperative pain management, suture, drain or splint removals, supplies, etc. If is important to note here that simply assigning a different diagnosis code than the one that necessitated the procedure does not mean it is unrelated. An infected postoperative seroma (998.51) may occur after a lumpectomy for breast cancer (174.9). The management of this wound infection does not meet the criteria for an unrelated evaluation and management and therefore, even though there is a different diagnosis code assigned, modifier 24 would not be appropriate. Boot Camp 1- Day E/M Auditing Boot Camp Earn 8 AAPC CEU's and cover topics such as medical decision making, grey areas of auditing policies, medical necessity and more! Upcoming Classes: Atlanta, GA: March 11 Instructor Shannon DeConda Dover, NH: April 6 Austin, TX: April 19 Little Rock, AR: April 20 Ft. Lauderdale, FL: May 17 Additional dates and cities scheduled; click the image above for full schedule Current NAMAS members save $100 on Boot Camp registration! Click here for details
3 So, when is modifier 24 appropriate? Modifier 24 is reportable on an evaluation and management service beginning the day after the procedure. The provider must specifically indicate one of the following situations: that the service was either for a problem unrelated to the surgery, exclusively for treatment of an underlying condition and not for post-operative care, management of immunosuppressant therapy if during post-op of a transplant, management of chemotherapy, or for unrelated critical care. This Week's Auditing & Compliance Tip Provided By: Sara San Pedro, CPC, CEMC, CPMA Sara is the Director of Quality Assurance in the Department of Audit and Regulatory Compliance for our parent company, DoctorsManagement, LLC A Note From Our Parent Organization: DoctorsManagement, LLC NAMAS 8th Annual Auditing & Compliance Conference Pre-Conference: Dec Conference: December Location: Orlando, FL Our Special Offer Has Been Extended! Ends 03/31/16 Register for pre-conference & conference and receive a 1 year NAMAS Silver membership FREE!* Secure your spot with only a $50 deposit! Click the conference image above to register Weekly Tip Sponsor Easy Management System Our Easy Management System for dental or medical office management assist with areas of priority for your practice. As a unique medical and dental practice consulting firm, DoctorsManagement utilizes its access to a wealth of resources to help clients increase NAMAS Calendar of Events
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5 Click the image above to complete the survey. This survey will close on March 15, 2016 and winners will be selected and contacted by a NAMAS representative. Survey results will be published by the end of March for Registration Links Non-Members: namas@namas.co to learn how to attend these webinars A Note From Our Sponsor Compliance Risk Analyzer By Frank Cohen Group Our weekly auditing & compliance tip s are available to anyone who could benefit from this information. IF you know someone who would like to receive these s, invite them to sign. Click the image above to be added to our list! Think of Compliance Risk Analyzer as a roadmap to compliance risk management. This interactive tool lists critical risk issues for each provider based upon a statistical review of your claims. Click the image above to learn more and request your free analysis! Stay Infomed Stay up to date with important news and announcements from NAMAS. Follow our social media pages to ensure you don't miss a beat! Copyright All Rights Reserved.
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