Medicare Modifier for Global Period

rksaleh

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A hospitalist bills Medicare for 36589, then Medicare denies payment on every 9928X for the next 10 days due to global period on 36589.
Does anyone have advise on what modifier Medicare is looking for on the 9928X codes in order to get them paid during this global period?
 

Donna T

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Modifier -59 would be incorrect as 9928X is an ER code and not a procedure code. Was the patient seen for problems related to the procedure or for unrelated reasons and was it the same hospitalist who is billing the 9928X? If the patient is being seen for services related to the procedure than it is included in the global. If it is for other reasons then you'd bill using a -24 modifier. If it was a different physician seeing the patient for the 9928X then I believe you would use a -55 modifier. Anyone else have any other ideas?
 

rksaleh

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I'm sorry! I indicated the wrong "post op" code that we are trying to get paid for! Here's the correct scenario.
Our physician bills for 36589 (for which Medicare has a 10 day global period/post op period) for a hospital inpatient. The same physician sees the patient numerous days in the hospital following this procedure and bills 9923X (subsequent hospital care).
I believe our coders have tried modifiers: 79, 24 & 59.
Any advise?
Thank you to all!
 

mitchellde

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79 and 59 cannot be used on E&M codes. the hospital aftercare is included in the global and unless you have a different reason for seeing the patient as supported by the documentation and a different unrelated diagnosis code there is not you can do. The 24 is the modifier to use if you do have an unrelated dx code.
 
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Sounds to me like procedural follow up care. If so then it's not billable during the global.
It also sounds like your coders are just coding to get pd by throwing all those modifiers on there and resubmitting the claim. Do your coders have AAPC certifications?
 
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