Question Global Period Billing

Dcrespin

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Need some clarification. The practice I work at does injections on patients. The visit usually consist of an office visit to discuss the issue they are having, what sites to do the injections, other health issues that they are having and so on. In most cases these visit last longer and the doctor likes to bill based on time. We bill 99214, 99354 and then the injection codes. Almost all of the payers are denying 99354 as global. We also have the patients sign and ABN for these visits. The provider wants me to bill the patients for any services not covered by the ins companies including the global denial. My questions are....can we bill for global denials? Also is there a modifier to use to get the ins companies to pay the extended code?
 

CodingKing

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ABN (which is Medicare only form) cannot be used for bundling denials. If doc is contracted with insurance, you cannot balance bill for denials that list as provider liable. prolonged E&M should be rare so be careful as billing based on time consistently will trigger an audit. Typically E&M isn't payable either as the decision to perform a minor E&M and standard pre-op are not separately payable.

NCCI Manual, General coding guidelines chapter 1 section D:

If a procedure has a global period of 000 or 010 days, it is defined as a minor surgical procedure. In general E&M services on the same date of service as the minor surgical procedure are included in the payment for the procedure. The decision to perform a minor surgical procedure is included in the payment for the minor surgical procedure and shall not be reported separately as an E&M service. However, a significant and separately identifiable E&M service unrelated to the decision to perform the minor surgical procedure is separately reportable with modifier 25. The E&M service and minor surgical procedure do not require different diagnoses. If a minor surgical procedure is performed on a new patient, the same rules for reporting E&M services apply. The fact that the patient is “new” to the provider is not sufficient alone to justify reporting an E&M service on the same date of service as a minor surgical procedure. NCCI contains many, but not all, possible edits based on these principles.

Example: If a physician determines that a new patient with head trauma requires sutures, confirms the allergy and immunization status, obtains informed consent, and performs the repair, an E&M service is not separately reportable. However, if the physician also performs a medically reasonable and necessary full neurological examination, an E&M service may be separately reportable.
 

manne06

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ABN (which is Medicare only form) cannot be used for bundling denials. If doc is contracted with insurance, you cannot balance bill for denials that list as provider liable. prolonged E&M should be rare so be careful as billing based on time consistently will trigger an audit. Typically E&M isn't payable either as the decision to perform a minor E&M and standard pre-op are not separately payable.

NCCI Manual, General coding guidelines chapter 1 section D:
Do we bill for the E/M and not the procedure or bill for the procedure and not the E/M? This is in general say if a there is an ER visit and a minor procedure is performed.
 
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