Q&A Cervical cerclage and Global Period

[louise]

The global period for cervical cerclage is 0. During a 99214 visit performed by the surgeon, a decision for surgery is made the day before the surgery. Should the 57, 25, or 24 modifier be used?

The note for this exam uses these phrases:
ADMITTING DIAGNOSIS: Decreased cervical length with suspected incompetent cerix
HPI: “Her history did not seem overly convicing for incompetent cervix.”
HPI: “…with the patient’s questionable history the decision has been made to proceed with cervical cerclage.”
ASSESSMENT: “…history questionable for incompetent cervix, and now has decreased cervical length.”
PLAN: “… cervical cerclage has been scheduled for tomorrow.”

Would you code 654.5? I picked 654.4.
Thanks in advance for any comments and help.

 

[louise]

This is a practice question in a exam prep book by Buck. I am struggling with this because I don't understand the answer.

Cervical cerclage: 59320 has a global period of 0 (zero)
Text says to code 99214-24 for decision for surgery "to indicate that this service is totally separate from the obstetric global package for a complication of the pregnancy."
Codapedia states: "A physician practice may bill patients for some services outside the package. A patient with complications, and requires more than the usual visits may be billed with office visits during the prenatal period. Use the complication first (hypertension, etc) and the pregnancy diagnosis second for these visits billed outside the global package. Bill these when they occur, not at the end of the delivery." - See more at: http://codapedia.com/article_266_Global-obstetric-package.cfm#sthash.BdSBkBzT.dpuf
This all sounds fine except the use of the 24 modifier. Reading the definition for 24, I don't see how it applies in this example.

As for the ICD code, it is clear to me that incompetent cervix is not the diagnosis here. I will stick to my guns and say 654.4 is correct.
Thanks for listening!