Wiki included in global??

[kostecki]

I'm feeling stupid this morning.

Can anyone help me out:

One of our doctors saw a patient in the hospital while she was on call; this patient was admitted for asthma but was pregnant too. She was admitted on 12-16, delivered via C-sect on 12-18 (59514), and was discharged 12-22.

the insurance is denying 99232 from 12-18 and 99238 from 12-22 stating they are included in the global proc. Can the doctor not charge for seeing the patient these days since she did the C section?

 

[amjordan]

The only way you might get reimbursed is if the documentation for the 99232 shows a clear decision for surgery. We had a similar case and the patients condition had begun to deteriorate which necessitated the need for the C-section. We billed it with the modifier -25 since the 59514 has no Global days. As for the discharge, I would appeal based on the grounds that the delivery only code does not have global days and the discharge should be reimbursed.