Wiki Modifier 24 but different physician???

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Grintwig

Grintwig

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:confused:
I have a real stumper here. We are being denied the office visits for a patient who had surgery elsewhere, wasn't happy with the results, and decided to come to us for another opinion. Subsequently we saw her several times. Our denials are due to the golbal period for the procedure the other physician did. Is there any modifier I can use?
Modifier 24 specifically states that it is used for the "same" physician during the global period????
 
Even if we didn't make an agreement with the former physician to manage this patient?
And we aren't strictly managing her previous condition.
 
55 must be appended to the surgical code provide by the surgeon and there must be a transfer of care request on the chart. Meaning the surgeon must either write an order for the patient to follow up with you or request directly that you take over care. Otherwise this is elective patient decision and must be billed to the patient, the payer has already paid the surgeon for the global and the surgeon (it sounds like) had every intention of performing the post op, the patient however had other independent thoughts so it is patient decision. Think of it this way if you had your hair cut and after leaving the salon you absolutely hated what you had and decided to go to another salon to have it fixed, then you would have to pay again whereas if you went back to the same person they would be obligated to fix it without charge.
 
She should go back to the original surgeon if she is unhappy and if he can do nothing then she could complain to the state, what kind of surgery was this and what is her complaint?
 
She had a lap chole, an EGD, and a colonoscopy elsewhere and came to us because she still had epigastric pain, spasms, nausea, and vomiting. We saw her a few times in the office and twice in the hospital. no procedures were performed and every one of our claims were denied as global. We ended up refering her to a gastroenterologist. (We are General, Vascular, and Throacic surgeons)
 
So your visit were in the global of the lap chole? If she were still having those issues then that definitly should go back to the original surgeon that did the lap chole. Sorry this type if thing is very hard for well meaning physicians.
 
I just got off the phone with a Medicaid Rep and he told me to append a 24 even though we are not the same physician who performed the procedure??
I'm going to try it but the CPT and Medicare specifically state that 24 is for when the SAME physician provides care in the global period....
 
I think that is really bad advice. Clearly this is surgery related and is part of global, unfortunately it is too late to get a transfer of care. My opinion but I firmly believe this should be converted to patient responsibility.
 
Same diagnosis

If you are using the same diagnosis as the surgeron then medicaid will deny those visit's as global regardless of billed the visits. We have this problem with oncology. We will see a patient and refer them to general surgery for a line placement for chemo and all our visit's are denied because we both billed with the neoplasm diagnosis. No way around this unless there is another diagnosis which for oncology there isn't.
 
Can't bill Medicaid Patient

At least in Wisconsin you cannot bill the Medicaid patient directly for services that are denied due to global (or no auth, or the Medicaid fairy was having a bad day).

Good luck.

F Tessa Bartels, CPC, CEMC
 
I have a similar issue with NC Medicaid. They will deny for global when a patient has a procedure done at another hospital by a completely different physician group, and when seen by our physician at his local hospital for complications...all of our visits are denied. Has anyone had any luck appealing these issues?
 
jkirasich said:
I have a similar issue with NC Medicaid. They will deny for global when a patient has a procedure done at another hospital by a completely different physician group, and when seen by our physician at his local hospital for complications...all of our visits are denied. Has anyone had any luck appealing these issues?[/QUOTE

FYI: I have also been told by Medicaid that we need to append modifier 24. I was told that per their guidelines, modifier 24 can be used with a different provider if the same specialty as the provider who performed the global service.
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