How To Code E/M During The Post-Op Global Period

When is it appropriate to code for an evaluation and management (E/M) service while a patient is in the post-op global period? The only circumstance in which this would be appropriate is when the problem being evaluated and managed is unrelated to the problem for which the patient is in the global period.

The 24 modifier indicates an “unrelated evaluation and management service by the same physician during a postoperative period.”¹ The 24 modifier description reads as follows: “The physician may need to indicate that an evaluation and management service was performed during a postoperative period for a reason(s) unrelated to the original procedure.”

An example of when it is appropriate to code an evaluation and management for a patient who is in a global period would be for a patient who is one month out from a bunionectomy and during a post-op visit, the doctor identified tinea pedis and prescribed a treatment for it.

An example of when it would not be appropriate to code an E/M during a global period would be if that same bunionectomy patient developed a post-op infection at the surgical site and the doctor managed it by taking a culture of the drainage and prescribing antimicrobial therapy. If this patient is admitted for this post-op infection and the surgeon follows up with the patient in the hospital, it would still not be appropriate to use the 24 modifier on hospital evaluation and management services as the infection is related to the original procedure.

Reference

1. APMA Coding Resource Center. Available at www.apmacodingrc.org .