Wiki 99213 Denied

[afroehlich]

I am a new coder and am confused why this was denied. My Dr. submitted a 99213 for a visit 3 days prior to surgery. In his notes he outlined the procedure, complications, recovery, medications (informed proper dosage & side effects), and use of post-op equipment. This was denied for not qualifying for a 99213. His notes also included statement that he spent 30 minutes face-to-face consultation of the above mentioned items. Can anyone explain why this was denied.

 

[mitchellde]

was the surgery already scheduled? if so this visit is considered inclusive to the surgery as a pre op encounter. Surgery global includes pre op, surgery, and post op.

 

[afroehlich]

Even though 3 days before the surgery was scheduled and therefore falls outside of the definition for global?

 

[mitchellde]

yes even though 3 days prior. The surgery was prior scheduled, this conversation and counseling is considered part of the surgery, it probably need to take place the visit where the decision for surgery was made.