Global period denial

jmeberst314@gmail.com

Contributor
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23
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Orlando, FL
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Hi,

I have a tricky situation here and I need some assitance. I have an E&M visit dated 12/18/2013 that was paid on by UHC but they took the money back due to the 90 day global period of a procedure on 12/19/2013. Now UHC says that I can send in a corrected claim with the appropirate modifier but I don't know which to use. Modifier -24 is for an unrelated E&M during the post operative period and -56 is the preoperative management but my office visit was a medication follow up and wasn't directly related to the surgery. What should I use to get the claim paid?
 

OCD_coder

True Blue
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Nashville AAPC Chapter
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It kind of makes me wonder if you have the same diagnosis on both claims? If so more information is needed with the diagnosis, and surgeries billed to help determine how to help.

A modifier 24 may be needed or a modifier 57, as the global period includes the day before surgery for 90 day global surgeries; without reviewing the notes it's just hard to say in a forum.
 
Messages
626
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Hi,

I have a tricky situation here and I need some assitance. I have an E&M visit dated 12/18/2013 that was paid on by UHC but they took the money back due to the 90 day global period of a procedure on 12/19/2013. Now UHC says that I can send in a corrected claim with the appropirate modifier but I don't know which to use. Modifier -24 is for an unrelated E&M during the post operative period and -56 is the preoperative management but my office visit was a medication follow up and wasn't directly related to the surgery. What should I use to get the claim paid?
Was this a procedure with a 90 day global period? If so you will need to add the 24 modifier because the post op global includes the day before the surgery too.Which is what your date was. The 57 modifier would not be correct because that is for the e&m that resulted in the decision for the surgery and clearly this did not. If you google"Medicare Global Surgery fact sheet" you can read all about it and might be easier to understand. :)
 
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