Wiki Global Period 99213 & 11900

[sexysassy]

My cpt code 99213 was denied on 10/14/19 stating it's included with the 11900. Why would that be? Global period for 11900 is 10 days per CMS and the office is for a different dx. Can someone please explain. Locations of the injections was at the same area. Thank you.


9/19/19 same codes billed and paid



10/31/19 same codes billed and 99213 denied.

 

[sexysassy]

Any thoughts on this?

 

[thomas7331]

It is not the 11900 that is causing this. If a service is denied as being part of a global period, then is it denying due to a code in the patient's prior history that has a global period which is encompassing the current claim. You'll need to look into your patient's claim history going back as far as 90 days to find what is causing the denial. If you're unable to find a code with a global period in your system in the prior 90 days, I'd suggest calling the payer. They should be able to tell you exactly what claim created the global period that resulted in this denial.

 

[sexysassy]

This was very helpful. Thank you.

 

[TESSA2019]

I think your office visit (99213) was denied because it is being bundled with the 11900. Possibly add a modifier 25 if ......... see below example:
Example, a patient comes for evaluation of a new lesion on the arm. The physician examines the lesion, discusses possible diagnoses and treatment options, and decides to biopsy the lesion. All of this care is included in the CPT code 11100 for skin biopsy. It would be inappropriate for the physician to bill an office visit with code such as 99213 in addition to the 11100 CPT code. However, if the same patient also mentions they have scalp itching, and the physician examines the scalp and diagnoses the patient with seborrheic dermatitis, a “25” modifier would be used to indicate that the patient had additional dermatologic issues addressed during the office visit outside of the condition that required a procedure.

 

[sexysassy]

thank you