October 17, 2019

Question:
A patient had a T&A and had a bleed. She came to office and saw my doctor.  My doctor wants to charge an office visit with a 24 modifier for an unrelated E/M service in the global period.  He states that the bleed is not related because is it not usual after a tonsillectomy.  What do you think?

Answer:
We do not agree with using modifier 24 in this situation.  Clearly the tonsil bleed is related to the procedure; therefore, it is considered a complication.  Medicare, and Medicare payors, say the treatment of complications in the office is included in the payment for the surgical procedure and should not be separately reported. If the patient is not Medicare, or a payor that follows Medicare payment rules, then you could potentially the office visit (or bleed treatment code) without a modifier and see if it gets paid. Don’t forget, the patient will likely have a co-pay for the visit if it is payable.

*This response is based on the best information available as of 10/17/19.