Wiki Global Days for Unlisted Codes?

[SUEV]

I had to use an unlisted code for an internal hemorroidectomy (46999). Hemorrhoidectomy codes usually have a 90 day global but since I'm using an unlisted, should I charge for the post-op visits?
Thanks,
Sue

 

[RNCPC0709]

You can bill for post op visits

Flashcode gives this for global surgical period, "XXX=The global concept does not apply to the code."


You would be able to bill for post op visits based on this.

 

[Erica1217]

I think if the insurance company pays you at a rate that is consistent with a similar 90-day procedure, then you should treat it like a 90-day procedure. That's another reason why it's important to track payments for unlisted codes. You should have an idea of what would be fair for the services rendered (including post-op care) and if not paid to your expectations, you need to appeal. I do this quite often and am very successful. Also, from a patient's point-of-view, it wouldn't be fair to them to get bills for co-pays for post-op visits. Good luck.

 

[FTessaBartels]

I agree w/ Erica

Very well said, Erica! I completely agree.

F Tessa Bartels,CPC, CEMC

 

[SUEV]

Appeals

Thanks for the advice. Erica, when you appeal something like this, do you state that you're seeking compensation that reflects a global period? Since Medicare assigns "global concept does not apply" to unlisted codes, do you appeal those too to make them apply the global concept?
Sue