csmith90
Contributor
- Messages
- 12
- Location
- Billings, MT
Hi All,
I've recently received two denials from Medicaid and I am stumped on what to do.
Patients were seen for greater & lesser occipital nerve blocks for occipital neuralgia, cpt codes 64450 & 64405, icd 10 code M54.81. Both codes were submitted for a single encounter date as they were done during the same visit and with only one modifier to indicate laterality as I saw no CCI conflicts when I ran them through Encoder.
Medicaid has sent back this response for their denial:
"The procedure codes 64450 and 64405 on the claim have a global day of “000” and there is no modifier on the lines to indicate the reason the procedures were performed during the global period of each other."
And they have provided information for modifiers 58, 76, 77, 78, and 79.
I am a new coder but as I read this it seems contradictory to me. They have no global period and were completed the same day, so how can there be a missing modifier? We reached out again to get a better explanation and received this in response:
"A SURGICAL OR MEDICAL PROCEDURE IS BILLED WITHIN THE GLOBAL PERIOD OF ANOTHER PROCEDURE:
IF THE PROVIDER BILLING THE MEDICAL/SURGICAL PROCEDURE IS THE SAME PROVIDER OR A DIFFERENT PROVIDER OF THE SAME SPECIALTY AFFILIATED WITH THE SAME GROUP AS THE PROVIDER BILLING THE SURGERY, AND THE RBRVS INDICATOR IS EQUAL TO "000" AND THE OTHER MEDICAL/SURGICAL PROCEDURE IS BILLED THE DAY OF THE PROCEDURE AND MODIFIERS 58 OR 76-79 ARE NOT PRESENT.
The Center for Medicare and Medicaid (CMS) publishes a Global Surgery Booklet. The booklet outlines billing of a Global Surgical Package and can be accessed on the CMS website. I have attached the CMS 2026 Global Booklet from their website."
And they attached the PDF for the mln global surgery booklet.
Is anyone able to explain to me what they are trying to get at? Any and all help is greatly appreciated!
This is for the physician billing for a pain management group.
I've recently received two denials from Medicaid and I am stumped on what to do.
Patients were seen for greater & lesser occipital nerve blocks for occipital neuralgia, cpt codes 64450 & 64405, icd 10 code M54.81. Both codes were submitted for a single encounter date as they were done during the same visit and with only one modifier to indicate laterality as I saw no CCI conflicts when I ran them through Encoder.
Medicaid has sent back this response for their denial:
"The procedure codes 64450 and 64405 on the claim have a global day of “000” and there is no modifier on the lines to indicate the reason the procedures were performed during the global period of each other."
And they have provided information for modifiers 58, 76, 77, 78, and 79.
I am a new coder but as I read this it seems contradictory to me. They have no global period and were completed the same day, so how can there be a missing modifier? We reached out again to get a better explanation and received this in response:
"A SURGICAL OR MEDICAL PROCEDURE IS BILLED WITHIN THE GLOBAL PERIOD OF ANOTHER PROCEDURE:
IF THE PROVIDER BILLING THE MEDICAL/SURGICAL PROCEDURE IS THE SAME PROVIDER OR A DIFFERENT PROVIDER OF THE SAME SPECIALTY AFFILIATED WITH THE SAME GROUP AS THE PROVIDER BILLING THE SURGERY, AND THE RBRVS INDICATOR IS EQUAL TO "000" AND THE OTHER MEDICAL/SURGICAL PROCEDURE IS BILLED THE DAY OF THE PROCEDURE AND MODIFIERS 58 OR 76-79 ARE NOT PRESENT.
The Center for Medicare and Medicaid (CMS) publishes a Global Surgery Booklet. The booklet outlines billing of a Global Surgical Package and can be accessed on the CMS website. I have attached the CMS 2026 Global Booklet from their website."
And they attached the PDF for the mln global surgery booklet.
Is anyone able to explain to me what they are trying to get at? Any and all help is greatly appreciated!
This is for the physician billing for a pain management group.