Wiki Global E&M Question

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mkees

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I need some opinions for this scenerio:

My doc did 2 surgeries on a pt-01/14/09 on the rt knee and 02/09/09 for the lt. We have a follow-up visit on 04/27/09 that addresses both knees. We billed an office visit with the mod 24 because the rt knee is out of the global from 01/14/09-ins is denying saying it is global.

Is this correct? I'm on the fence...yes a new global started on 020909, but it is on the other side of the body and the foloow-up shoould be allowed with the mod is my opinion.

Thanks
MKees:)
 
Just a thought...

Since the notes show that the appointment was a follow up on both surgeries, you may not be able to really do anything about it.

The other option is to code the office visit with -25 & RT, then the post op with a -LT to see if that will work.

Just a thought! Good luck
 
I agree that you should be able to bill the office visit with a -24 since that knee is out of the global period. Just a thought, are the diagnosis codes different for each knee? In the past, we've had insurance companies deny the exact same scenario when the diagnoses for both were the same. In that case, I would appeal.
 
I have this happen a lot, we have a hand surgeon who does this frequently for carpal tunnel. I do bill the office visit with a 24 and the RT of LT and sometimes I do have to appeal this, but it is billable and payable:)
 
Thanks for your thoughts and opinions, I will do a final appeal.

Thanks!
 
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