Wiki 30140 & Global Periods

[mmart1223]

We billed Oxford the following 5 codes:

31296 -50 51
31297 -50 51
31295 -50 51
30520
30140

18 days later we billed Oxford 31237 -50 79 with the same dx we used for the procedure and it was performed by the same MD.

Oxford denied the post-op citing the visit fell within the global period.

My question is: 30520 & 30140 are the only two CPTs that have 90 day global periods while the other three have 0. When multiple procedures are performed and at least one of the codes has a 90 global period, does this automatically give the entire procedure a 90 global period?

Thank you in advance!

 

[JenniferB7]

No it doesn't. If 31237 was performed for conditions related only to 31295-31297 and not in anyway related to 30520 to 30140, then it should not be bundled into the global periods for 30520/30140. Having said that, you will want to make sure your documentation is solid since you have to go through the nasal passages to reach the sinuses. The documentation should clearly support "sinus debridement", not removal of crusting or other debris from the nasal passages, septum, or turbinates. If so, then you will want to appeal to Oxford.

Here is a policy statement from AAO-HNS that you can use to support your appeal argument: http://www.entnet.org/content/position-statement-debridement-sinus-cavity-after-ess

Hope that helps!

 

[mmart1223]

Thank you so much!