Wiki Critical Care visit denied as global ?????

[angelwlkns]

UHC dening critical care visit as global to anesthesia time procedure.
The procedure was done on 05.01.09 and we billed CC visit on
05.02.09. Does anyone have any ideas on how I can appeal?

I have sent in medical records and still got denied.

Thanks

 

[NFBarner]

You could submit it with a 24 modifier if it is an unrelated E/M service by the same physician during the postoperative period.

 

[dwaldman]

This is from UHC's Reimbursement policies on www.unitedhealthcareonline.com



According to the ASA, basic value anesthesia services include the usual pre- and post- operative visits. Evaluation and management (E/M) codes are considered part of the anesthesia management service one day before, the same day, or one day after anesthesia management was provided by the same physician and/or other health care professional of the same group and ame specialty reporting the same Federal Tax Identification number.

When the physician or other health care professional is providing an E/M service (including Critical Care E/M services) unrelated to the anesthesia service on the day after the anesthesia management service, the appropriate E/M code may be submitted with modifier 24 indicating an unrelated E/M service was rendered during a postoperative period.

When the anesthesiologist is providing critical care services, the appropriate critical care evaluation and management (E/M) code (99291-99292, 99468-99476, and 99477-99480) may be submitted with modifier 24 or 25 indicating a significant and separately identifiable service by the same physician on the same day as an anesthesia management service was rendered.