Wiki M144 (denial pre/op Op include in allow 4 surg)

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amanda19791

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I need some guidance the denial for M144(pre/op Op incl in allow 4 surg). So we billed 99219 & 99225 and according to BCBS State they have denied the 99225(pre/op include in allow for surgery). Should we not bill the 99225 since BCBS state see that 99219 is the only code to use before the surgery.
 
what day did you bill for 99225? (same day as surgery, day before) what is the surgery and what is the global period for that surgery?
 
amanda19791 said:
The 99225 was billed on a different(the next day). The surgery(49501) was billed the day after 99225.
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The surgery (49501) is a major surgery, and the visit before that was billed as a 99225 (subsequent observation). Is this a facility claim or professional claim? was 99219 billed the day before 99225 (a whole 24 hours)? Was a 57 modifier used for the visit the day before surgery? (If of course the decision for the surgery was made on the DOS with the procedure code 99225.)

Its really hard for me to see exactly why this is denying because i don't really have all of the information in front of me. I would read the CPT guidelines for "Initial Observation Care" pg 14 in your 2020 CPT book and compare it to the documentation in the hospital records.

I hope you find the answer you are looking for. If you need more information do not hesitate to contact me.

Thanks
Misty
 
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