Global Denial - out of sequence dates of service

mgord

Guru
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105
Location
Columbia
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We have a claim that denied as being included in the global period of another procedure, however this was the first surgery we had performed on this patient. When I called Cahaba I was told the claim was billed out of sequence with a subsequent procedure performed 2 weeks after the first surgery. I was told that we had to add a modifier indicating that this was related/unrelated to that global period even though the date of service was after the first procedure. I'm confused though because there were multiple procedures billed with this original surgery and they were all paid except for the primary CPT. Has anyone else had this happen? I'm very confused. Thanks for any assistance!!
 

philipwells

Guest
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92
Location
Birmingham
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Yeah I'd typically say use 58,78, or a 79 modifier depending on the situation but all those modifiers clearly state "same physician". May need to appeal on the basis that it wasn't the same physician therefore your surgery shouldn't be global to anything. I'd also like to know if I'm assessing this case correctly. Any additional information would be helpful.
 

pamsbill

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113
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What CPT code are you billing? Also, clarify the situation - they are saying another practice billed a procedure before yours and it is causing yours to deny because of the global period of the other claim? Will they tell you what was billed and by what type of practice?
 
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