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Wiki Denial of exam with modifier -24

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edmedbilling

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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
 
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.
 
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