Wiki Denial of exam with modifier -24

[edmedbilling]

Hello,
If a payer (Humana) denies an exam with modifier -24 and we have sent in an appeal with documentation showing it is unrelated to the global period what recourse do we have or what can I cite to show that we have billed it correctly and met all the criteria and they are in violation established guidelines?

Thanks,
Edward

 

[podcoder70]

If they deny after appeal then the likely culprit is the documentation, it is not clear enough to make known that the e&m was unrelated to the procedure in global. If you believe the documentation is adequate, then you have to go through all levels of appeals.