Hospitalist consults and post op care during surgeons post op period

Ethanzoe

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I am coding for a Hospitalist group and having terrrible trouble with denials during our surgeons post op period because they all fall under the same taxonomy #. The Hospitalist group usually gets called in for post op consults and subseq. visits during our orthopedic and general surgeons post op 90 day global period usually following for HTN or Diabetes care ect. while in Inpatient care. BCBS has told us to use Mod 24 or Mod XP but I do not feel either of these are appropriate; different physician and is not Mod 59 appropiate on an E/M so why would I use X modifier. Up until recently I would have follow up appeal stating different specialties and different Dx used with some success. Any help as soon as possible would be greatly appreciated!!!!!!!!!!!

Thank you for your time,
 

thomas7331

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Hospitalists usually have an internal medicine specialty and their services should not fall into the global package of a surgeon's post-operative period, and you shouldn't need any modifiers to separate them if that's the case. I have coded for hospitalists who were employed by a group that also had surgeons and only very rarely ran into this problem. Are you seeing this specifically for one payer? You may need to speak to your network representative for that payer and see what is going on - there might be a system issue on their end that is not recognizing the specialties, or a provider may not have been credentialed correctly. That would apply for Medicare too - if the wrong box for specialty was checked on a provider's enrollment form, this could be causing denials too.
 

Ethanzoe

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I can not thank you enough for your help. This is the conclusion I kept coming to that this should pay without a Mod. I now have a direction to go to my manager about. I have been so frustrated with the payers not paying these saying if is fallling into the surgeons global.

Have a great day!!
 
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