Coding ‘covering’ physicians during the global period

Q Please explain what “by the same physician” means in the CPT definition of modifiers -24, -58, -76, and -79. Does it mean literally the same physician or can it mean within the same group practice and specialty, i.e., same tax ID number?

A Simply put, it means “the physician who performed the last procedure that initiated the global period.” What makes the situation more complex is how insurance companies process claims for physicians within a group practice and how they treat covering physicians during the global period. The question then becomes: How will my insurance company view the use of these modifiers for payment purposes? For instance, the modifier -24 means that the physician who performed the original surgical procedure is now seeing the patient for an unrelated problem (E/M service) during the global period. If all physicians in a single-specialty practice are considered the “same physician” for billing purposes, use this modifier to bypass the global period restrictions for postoperative care.

The same logic might apply to the other modifiers. For example, the modifier -58 means that the surgeon who performed the first surgical procedure is now doing a staged or related procedure during the global period of the first procedure; the modifier -76 signals that the surgeon who performed the first surgical procedure is repeating that procedure for a second time; and the modifier -79 indicates that the original surgeon is performing an unrelated procedure or service during the global period.

These modifiers also apply to “covering” physicians because, in most cases, this doctor is considered the same as the patient’s regular physician for billing purposes. The bottom line: The covering physician can bill for the same services and procedures as the regular clinician during the global period. The modifiers simply define the circumstances.

This article was written by Melanie Witt, RN, CPC, MA, former program manager in the Department of Coding and Nomenclature at ACOG. She is now an independent coding and documentation consultant. Her comments reflect the most commonly accepted interpretations of CPT-4 and ICD-9CM coding. When in doubt on a coding or billing matter, check with your individual payer.

Q Please explain what “by the same physician” means in the CPT definition of modifiers -24, -58, -76, and -79. Does it mean literally the same physician or can it mean within the same group practice and specialty, i.e., same tax ID number?

A Simply put, it means “the physician who performed the last procedure that initiated the global period.” What makes the situation more complex is how insurance companies process claims for physicians within a group practice and how they treat covering physicians during the global period. The question then becomes: How will my insurance company view the use of these modifiers for payment purposes? For instance, the modifier -24 means that the physician who performed the original surgical procedure is now seeing the patient for an unrelated problem (E/M service) during the global period. If all physicians in a single-specialty practice are considered the “same physician” for billing purposes, use this modifier to bypass the global period restrictions for postoperative care.

The same logic might apply to the other modifiers. For example, the modifier -58 means that the surgeon who performed the first surgical procedure is now doing a staged or related procedure during the global period of the first procedure; the modifier -76 signals that the surgeon who performed the first surgical procedure is repeating that procedure for a second time; and the modifier -79 indicates that the original surgeon is performing an unrelated procedure or service during the global period.

These modifiers also apply to “covering” physicians because, in most cases, this doctor is considered the same as the patient’s regular physician for billing purposes. The bottom line: The covering physician can bill for the same services and procedures as the regular clinician during the global period. The modifiers simply define the circumstances.

This article was written by Melanie Witt, RN, CPC, MA, former program manager in the Department of Coding and Nomenclature at ACOG. She is now an independent coding and documentation consultant. Her comments reflect the most commonly accepted interpretations of CPT-4 and ICD-9CM coding. When in doubt on a coding or billing matter, check with your individual payer.

Q Please explain what “by the same physician” means in the CPT definition of modifiers -24, -58, -76, and -79. Does it mean literally the same physician or can it mean within the same group practice and specialty, i.e., same tax ID number?

A Simply put, it means “the physician who performed the last procedure that initiated the global period.” What makes the situation more complex is how insurance companies process claims for physicians within a group practice and how they treat covering physicians during the global period. The question then becomes: How will my insurance company view the use of these modifiers for payment purposes? For instance, the modifier -24 means that the physician who performed the original surgical procedure is now seeing the patient for an unrelated problem (E/M service) during the global period. If all physicians in a single-specialty practice are considered the “same physician” for billing purposes, use this modifier to bypass the global period restrictions for postoperative care.

The same logic might apply to the other modifiers. For example, the modifier -58 means that the surgeon who performed the first surgical procedure is now doing a staged or related procedure during the global period of the first procedure; the modifier -76 signals that the surgeon who performed the first surgical procedure is repeating that procedure for a second time; and the modifier -79 indicates that the original surgeon is performing an unrelated procedure or service during the global period.

These modifiers also apply to “covering” physicians because, in most cases, this doctor is considered the same as the patient’s regular physician for billing purposes. The bottom line: The covering physician can bill for the same services and procedures as the regular clinician during the global period. The modifiers simply define the circumstances.

This article was written by Melanie Witt, RN, CPC, MA, former program manager in the Department of Coding and Nomenclature at ACOG. She is now an independent coding and documentation consultant. Her comments reflect the most commonly accepted interpretations of CPT-4 and ICD-9CM coding. When in doubt on a coding or billing matter, check with your individual payer.