1. L

    Wiki Humana Mod -79 Denial

    Hi, I have noticed denials from Humana on procedures billed with mod -79 performed during the global of another procedure. Commonly seen on cataract surgery done on the opposite eye during the global period of the first eye. Practice is also billing with laterality mods. For example, first...
  2. R

    17250 in Global Period

    I keep going back and forth on this. I have a patient who is status post mastectomy, and has been coming in weekly for post-operative visits. During these visits, the provider has been applying silver nitrate to the scar, but documentation states that the scar is healing normally. I'm of the...
  3. M

    Wiki Global Coding/Antepartum Care

    Very new to OB coding. Global codes always include antepartum, delivery, and postpartum, correct? So if a clinic only provides antepartum and postpartum care they shouldn't be billing global codes? They would bill E/M for 3 antepartum, 59425 for 1-3 antepartum, 59426 for 7+ antepartum, and...
  4. F

    Wiki Revision ACDF during global

    Patient has a fall within 2 weeks of ACDF and returns to the operating suite. New diagnosis is "mechanical complication of implant". Surgery is revision of ACDF with increased difficulty (22 modifier). My question is this: which modifier would you use? 58 - because it's more extensive than the...
  5. J

    Wiki 97607/97608 - Global or not Global

    The question is – with regard to 97607/97608 and global periods: Do these codes fall under the global period when a post-op patient follows up with the same surgeon for the same surgical site (anatomical)? Note: These codes state no global period (xxx). The concern is when a major surgery...
  6. 5

    Wiki SP surgery with 90 day global-follow up visit inpt is a inpt, had surgery, was seen in follow up visits for multi days - nothing out of the ordinary, just following up from the surgery. the surgery has a 90 day global. I feel its a 99024, but another coder in our office feels we can bill out a follow up visit. Can someone help...
  7. S

    Wiki Non Global Pre-natal Services

    Can anyone provide insight into why my antepartum code 59425 is denied for non-global care? Using ICD z3481. Thank you!
  8. A

    Wiki Diabetic counseling for OBs - payment outside the global package?

    I've researched this quite a bit on the internet and AAPC forum. I'm hoping to find out if there is an OBGYN clinic who has been successful at receiving additional reimbursement for Diabetic counseling to an OB patient. Our OBGYN clinic would like to institute diabetic counseling to diabetic...
  9. S

    Wiki Need advice on a global policy scenerio/issue ....

    Patient seen in observation by general surgery for consult for RLQ pain, fever & vomiting to evaluate for appendicitis. On 11.19 the surgeon clearly states in the consult "not likely surgical, will defer for further evaluation". Now, on 11.20, surgeon sees the patient again, decides that yes...
  10. J

    Wiki Failed induction charges

    If a patient is brought into the hospital to induce labor, but induction fails and patient is sent home without delivering, can we charge for hospital services? Or is this part of the global charges? If you have charged for failed induction, what CPT have you successfully used? She was brought...
  11. F

    Wiki * CNM Prolonged Services *

    I work at a FQHC organization and we have a CNM who spends prolonged hours with a patient. She is in attendance at all times, but does not deliver, only monitoring. My question is as an FQHC, are we allowed to charge for prolonged services because she does not get reimbursement for the delivery...
  12. C

    Wiki Surgeon Sees Patient in ER

    Patient had tonsillectomy one day prior to ER Visit. Surgeon met patient in Emergency Room due to N/V with blood. Fluids given and bleeding controlled prior to patient leaving the ER. Since this is within the global period for the surgeon, does this mean that a ED Professional Level can not...
  13. C

    Wiki Antepartum Care - Billing Outside the Global

    Can anyone provide clarification on what can be billed outside the global for antepartum care?
  14. R

    Wiki Global Period Modifier Scenario

    Patient had an eye surgery done that has a 90 day global period. Patient then had a second procedure done on same eye 2 weeks later (modifier 58 was used since it was staged) but this second procedure only has a 10 day global period. Patient is about to have a third procedure done on the same...
  15. C

    Wiki Repeat of minor surgery during global

    If a minor surgery needs to be repeated during the global period, and is done in the exam room (thus you can't use modifier 78), is this ever billable? For example, an I&D of an abscess is performed (which has a 10 day global), but a few days later the patient returns because the abscess has...
  16. P

    Wiki Readmission during postoperative period

    Hello! Here's the scenario: Patient is admitted for appendicitis and has an appendectomy (90 day global). The patient is discharged and sent home. The patient returns to the ER 2 weeks later for abdominal pain and is admitted for suspected abdominal abscess. Question: Would all of the E/M...
  17. M

    Wiki Global period - an I&D was done

    an I&D was done on a patient and five days later an atherectomy was done. medicare is denying claim due to global period. the i&d was done on the back. atherectomy done on the lt. what can i do to get this fixed?
  18. K

    Wiki are visits for complications for 10060 fall under the global or can we bill for them?

    I know that 10060 has a 10-day global but what exactly does that cover? We saw a pt 5 times within the 10 day period after the procedure for infection and repacking. Can we bill these out and if so what are the codes? Any help would be appreciated.
  19. H

    Wiki ICD10 Global ob billing

    With the new year and so many patient's changing insurance, we have to bill ob visits from 2015 to one insurance, not included in global. We are having trouble with some insurance companies denying our claims even though we are billing semester and weeks gestation as dx code.
  20. M

    Wiki Hospitalist as attending physician for Orthopedic surgical inpatient

    We are a small Critical Access Hospital. Our orthopedic surgeons (who are not employed by us) have asked our Hospitalists to act as the attending physicians for their fractured hip cases. They ask that the Hospitalist perform the admitting H&P to clear the patient for surgery and then...
  21. J

    Wiki UHC and knee xrays

    Is anyone else having issues with United Healthcare (Community Plan and United Healthcare Shared Services) denying E&M codes inclusive to knee xrays (specifically 73560)? We are an orthopaedic group that frequently performs knee xrays on patients. I have contacted both insurance carriers...
  22. K

    modifier 80 and 78 to medicare - Need help with this

    Need help with this. One of our docs assisted an OUTSIDE doc on CPT 35665 and 37618. I know I need modifier 80. Here is the dilemma ....this procedure takes place within the global period for a DIFFERENT procedure that one of OUR docs did. Do I also need modifier 78 along with the 80 because...
  23. K

    Wiki modifier 80 and 78 to medicare

    Need help with this. One of our docs assisted an OUTSIDE doc on CPT 35665 and 37618. I know I need modifier 80. Here is the dilemma ....this procedure takes place within the global period for a DIFFERENT procedure that one of OUR docs did. Do I also need modifier 78 along with the 80 because...
  24. M

    Wiki Global Denial - out of sequence dates of service

    We have a claim that denied as being included in the global period of another procedure, however this was the first surgery we had performed on this patient. When I called Cahaba I was told the claim was billed out of sequence with a subsequent procedure performed 2 weeks after the first...
  25. C

    Wiki Post op visits after global periods are eliminated

    Supposedly, CMS is eliminating 10 day post op periods in 2017 and the 90 day post op periods in 2018. Does anyone know how we'll bill for post op visits after the global periods are eliminated? I assume we'd use the appropriate 99xxx code but will there be special modifiers to indicate that...
  26. B

    Wiki Global EKG date of service

    I'm hoping I can get some opinions and perhaps some reference to documentation indicating which scenario is appropriate. Patient has an EKG performed on 2/1/16. The physician doesn't perform an official interpretation of this EKG until 2/5/16. Because it's all being done by the same...
  27. B

    Wiki billable or inclusive

    Hi, all I hope you all are doing well. I am new to OB coding ……. Here one of my OB provider had billed 99213 with O20.0 for a routine antepartum visit. This claim got denied as not payable and stated it will be inclusive within global service (59400 or 59510) .which is going to be billed in...
  28. L

    Wiki Change in the Global days for Ophthalmology Laser Procedures for 2016

    Two of our surgeons are questioning the decrease in global days from 90days to 10days for all laser eye procedures. Have found nothing to indicate a 10 day global period for codes 67210, 67220, 67228,67145, 66762, and 66821. Have found only two codes which indicate a 10 day Global Period 66761...
  29. T

    Wiki Non global package

    We had a patient (she has Molina insurance) seen on 7/15, 8/15, 9/8 and 9/22 and then 4 more times in October. How are we suppose to bill for dates of service before October 1st?? Do we bill as a low office visit. Insurance companies want ICD-9 and ICD-10 codes on different claims. I don't think...
  30. A

    Wiki 69209 cpt

    Does anyone happen to know if 69209 is going to fall within a global period? Thank you for any help! Amy M.
  31. M

    Wiki OB global vs office visit

    My understanding of OB is that if a pt is pregnant, there are 3 possibilities with regards to coding encounter. 1. Incidental - condition is not affecting the pregnancy - Office visit code used. 2. Routine antepartum visit - global billing place holder 59400PP is used and Dx Z34.- and Z3A.-...
  32. M

    Wiki 90 days post op

    ok, I need a little help, I know that 90 days post op claims will not be paid for they are included in the 90 global period and considered part of the package, however my administator wants up to send them and receive the denial just to have record of it and just so that we don't miss for say...
  33. B

    Wiki Global period for self pay patients

    Is there a policy anywhere about this. I have a doc who performed an amputation on an uninsured pt. The patient is now back in the offc for a reck (2 wks after surgery) and he is wanting to charge an office visit just because the patient does not have insurance. I don't feel that he should...
  34. tmallet

    Wiki Assistant surgeon Global?

    If a general surgeon was the assist on a procedure, would he be subject to the global period as well as the primary surgeon?
  35. B

    Wiki Bronchoscopy and Subsequent Hospital Visit

    I have found the following scenario when auditing for our pulmonologists: patient admitted to hospital, pulmonary consult is requested and done. The consult report states patient will need a bronch. Q 1. Does there need to be a request in the medical record from the attending...
  36. M

    19301 Follow ups/global rules

    One of my surgeons wants to charge a follow up visit when having a "cancer discussion" and reviewing a current MRI and deciding to return to surgery for Axillary node Disection - is the office visit chargable - or is it still part of global - example - DOS --6/8/9 19301 w/global of 90 - pt...