Wiki Consult and procedure on same day

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JCampbell

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Can anyone tell me if they have trouble receiving payment for a visit and procedure on the same day when done in the hospital? One of our surgeons seen a patient and then decided to perform surgery. We billed 99232-57(subsequent code used in place of consult code) along with the procedure on the same day and Medicare is denying.

Thanks for any help that you may be able to give.

Jennifer
 
The procedure is 32551 and the exact denial is CO-97:The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. M144:pre-/post-operative care payment is included in the allowance for the surgery/procedure.

Thanks!
Jennifer
 
JCampbell said:
The procedure is 32551 and the exact denial is CO-97:The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. M144:pre-/post-operative care payment is included in the allowance for the surgery/procedure.

Thanks!
Jennifer
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I'm not familiar with this procedure at all, so there's nothing that comes to mind immediately, but looking at the RVU file, 32551 has 0 days global period, which means the E/M the same day shouldn't need the 57. Maybe a 25 instead? Are there any other procedures performed/billed on the same day or in the 90 days prior that it might be included in?
 
JCampbell said:
No, there were not any other services performed during that time frame.

Thanks,
Jennifer
Click to expand...

Sorry I couldn't help more; the only thing I can see is that 57 could be changed to 25, since 32551 doesn't have a global period. Hopefully someone else can advise better :confused:
 
Some INS do not make a SEPARATE payment for E&M services same day as a 0 global day procedure -they will only pay for the procedure and this did need a 25 and not a 57
 
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