My question is we have a patient who underwent CPT® 61108 for an sdh back in may. Then he comes back to the hospital for a fall, and the mri showed another sdh in the same area. We billed the e/m visit to Medicare.. But denied for global period, however, I want to resubmit the claim with modifier 24 because technically this is not a complication of the previous surgery and the last sdh was evacuated..
The reason MCR denied the E&M was due to the first surgery and since you are billing our the same procedure but different incident, you need to add the modifier 24 and probaly send the office notes to show different procedure doing post-op. anytime you bill E&M's unrelated to the surgery you need to always add modifier 24. the new procedure will need a modifier also for return to the operating room during post op, modifier 79. you should also code this with the approiate E code to show that this was due to an fall and not related to the orginial procedure.
Personally I would appeal the decision due to the fact that the patient had a fall which (most likely) caused another SDH. The problem will be whether they argue the fact that the SDH was returning prior to the fall or not. I would appeal with the notes from your provider as well as radiology to support.