90 day global modifier on E/M

depaul

Contributor
Messages
12
Location
Colorado Springs, CO
Best answers
0
A Medicaid Pt had left foot surgery on 11/26/2019. On 12/11/2019 Pt returns to office for a visit and discusses surgery on right foot. Billed 99213, -24.

Medicaid paid the 12/11/19 E/M with modifier 24, (and paid the 2nd surgery DOS 12/24/2019). But Medicaid denied the first surgery 11/26/2019. I called Medicaid, the rep said the 1st surgery on the left foot on 11/26/2019 is denied because of the 12/11/2019 office visit because of the 24 modifier. Rep stated the office visit on 12/11/2019 needs the 90 day global modifier. I told her it has modifier 24. She said Medicaid does not follow CPT, they have their own guidelines, nor do they allow modifier 24. She said when I correct the 12/11/19 DOS with a 90 day global modifier then the 11/26/19 surgery will be paid.

Has anyone else come across this? And if not modifier 24, what 90 day global modifier is CO Medicaid wanting?

Thank you!!!

DP, podiatry
 

csperoni

True Blue
Messages
627
Location
Selden
Best answers
2
I don't bill for Colorado, but found this: https://www.colorado.gov/pacific/hcpf/med-surg-manual
Interestingly, under global surgery, it states "Payment for a surgical procedure includes the pre-operative, intra-operative, and post-operative services routinely performed by the surgeon. The post-operative period for each surgical procedure code is determined by the value given in the MPFSDB, and is either 0, 10, or 90 days. Evaluation and management services rendered by the surgeon during this period that are related to the original surgery are included in the payment for the surgery, and not separately reimbursable. The two procedures are considered to be related when the first three digits of the diagnoses are the same. Modifiers for reporting separately identifiable services during the postoperative period are described at the end of this manual."
Further down, -24 is listed as a valid modifier.
So that leads me to believe either:
Sharon's answer above, that the person didn't know what they're talking about OR
Your diagnoses are too similar and the insurance absurdly believes the left foot and the right foot are related. In that case, I would try an appeal.
 

depaul

Contributor
Messages
12
Location
Colorado Springs, CO
Best answers
0
Thank you both! Actually I had called last week and was told the same thing, they need the 90 global modifier on the E/M, not the -24 and that the DX is not the reason it was denying. I just called again and got a 3rd rep. This one right away said it is the DX. Because one of the DX is the same on both claims (different order). Which is one of the reasons for doing the surgery on each foot to begin with. Guess the 3rd time calling's a charm ;)

Thank you for your help!
 
Top