Post operative period Billing - Modifier usage
POST-OPERATIVE PERIOD BILLING
Unrelated Procedure or Service
or E/M Service by the Same Physician During a Post-operative Period.
Two CPT modifiers are used to
simplify billing for visits and other procedures that are furnished during the
post-operative period of a surgical procedure, but not included in the payment
for surgical procedure. These modifiers are:
• Modifier “-79” (Unrelated
procedure or service by the same physician during a post-operative period).
The physician may need to
indicate that a procedure or service furnished during a post-operative period
was unrelated to the original procedure. A new post-operative period begins
when the unrelated procedure is billed.
• Modifier “-24” (Unrelated E/M
service by the same physician during a post-operative period). The physician
may need to indicate that an E/M service was furnished during the
post-operative period of an unrelated procedure. An E/M service billed with
modifier “-24” must be accompanied by documentation that supports that the
service is not related to the post-operative care of the procedure. Special
Reporting for Certain Practitioners for CPT code 99024 Practitioners are
required to report post-operative E/M visits using CPT code 99024 if they:
• Practice in one of the
following nine states: Florida, Kentucky, Louisiana, Nevada, New Jersey, North
Dakota, Ohio, Oregon, or Rhode Island; and
• Practice in a group of ten or
more practitioners;
• Practitioners who only
practice in practices with fewer than 10 practitioners are exempted from
required reporting, but are encouraged to report if feasible and,
• Provide global services under
one of the required procedure codes. The required procedure codes are those
that are furnished by more than 100 practitioners and either are nationally
furnished more than 10,000 times annually or have more than $10 million in
annual allowed charges.
The term “practitioner” is used
to refer to both physicians and nonphysician practitioners (NPPs) who are
permitted to bill Medicare under the PFS for services furnished to Medicare
beneficiaries (see 81 FR 80172). This
reporting is required for post-operative visits during the global period
for procedures with dates of service on or after July 1, 2017. For more
information, see Claims-Based Reporting Requirements for Post-Operative Visits.
Codes for Which Reporting on Post-Operative Visits is Required As of January 1,
2018, there are some changes made to the list of codes for which reporting is
required.
These changes are made
necessary by changes in the coding system.
The following CPT codes no
longer need to be reported: CPT codes 15732, 34802, and 34825 are deleted.
Reporting is not required after December 31, 2017.
CPT codes 30140, 36470, and 36471 have a 0-day global period so reporting is not needed.
No comments:
Post a Comment