Modifier 24 and modifier 79.

Modifier 24 is appended to the E&M service code when a patient is seen during a global period. Each CPT code has a global period that varies from zero to 90 days (some carriers have longer global periods, e.g., 120 days). If you are seeing a patient in the office following a procedure that has a global period and the patient has a new diagnosis that is unrelated to the procedure, the 24 modifier will protect the service from being bundled into the global surgical package, and reimbursement should be permitted. A different diagnosis code (ICD) is required, and it must be linked. An example would be a patient with acute maxillary sinusitis who underwent a parotidectomy (90-day global period). In this case, the E&M visit would be 99xxx-24. It would require being linked to the ICD for acute maxillary sinusitis (461.0).

If you are seeing the patient for an unrelated surgical procedure during the global period, you must append modifier 79. For example, if you perform a scheduled endoscopic sinus debridement 4 days after a septoplasty (90-day global period) and endoscopic maxillary and ethmoid surgery, you might consider coding 31237-79 for endoscopic sinus debridement with the appropriate diagnosis code. Modifier 79 advises the carrier that this procedure is being performed during the postoperative global period.

It is important to know the global periods for the procedures performed so that you can be compensated for this unrelated service. Remember, if you are seeing the patient for a routine or problematic visit for a reason related to the parotidectomy, you will not be paid for additional services during the global period.

Steven F. Isenberg, MD

Dr. Isenberg is an otolaryngologist in private practice in Indianapolis; [e-mail]