A patient was seen for a right distal fibular fracture. A diagnosis code of S82.64XA (nondisplaced fracture of lateral malleolus of right fibula; initial active management) was billed with office visit and fracture care codes: CPT 99203 CPT 27786 (closed treatment of distal fibular fracture (lateral malleolus); without manipulation) The patient was seen for follow-up care at 6 weeks at which time the fracture was noted to be healed. The patient was asymptomatic at the fracture site, although there was still pain and laxity to the lateral collateral ligaments. At that time, the patient was placed in an ankle brace and prescribed physical therapy. Would it be appropriate to bill an office visit with a “-24″ modifier during the fracture care global period using a secondary diagnosis of an ankle sprain S93.491A?
The CPT description of the appropriate use of the “24″ modifier is “unrelated evaluation and management service by the same physician or other qualified health care professional during a postoperative period.”
Use this modifier (only on an E/M code) when you perform an evaluation and management service during the follow-up period of an unrelated surgical procedure. You are entitled to bill for an E/M service performed during the follow-up period if that service is not related to the original surgical procedure. If the case was unrelated to the surgery in the global period, you would add the “24” modifier to the E/M service code. You should reference this service code to the appropriate unrelated diagnosis on the billing claim if the E/M was unrelated.
The question is, are the two issues related?
The patient was initially diagnosed with a right distal fibula fracture, leading to the ICD-10-CM diagnosis code of S82.64XA (nondisplaced fracture of lateral malleolus of right fibula; initial encounter for closed fracture). The treatment performed was described with CPT 27786 (closed treatment of distal fibular fracture [lateral malleolus]; without manipulation). This CPT code set the 90 day postoperative global period. Within this postoperative global period, “the fracture was noted to be healed and the patient was asymptomatic at the fracture site, although there was still pain and laxity to the lateral collateral ligaments.”
Due to the close anatomical proximity of the distal fibula fracture and the lateral collateral ligaments of the ankle, can one really say that these two issues are not related?
My opinion is that they are related and it would not be appropriateto bill an established patient E/M service appended by the “24″ modifier associated with the ICD-10 code, S93.491A (sprain of other ligament of right ankle, initial encounter).
Michael G. Warshaw, DPM, CPC, DABMSP