Modifier 24

gcohen

Guru
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167
Location
West Chester, PA
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I have a payor denying a claim for a visit seen during the global period because it was submitted with the same diagnosis. Can I appeal this or is this accurate?

Thanks
 

csperoni

True Blue
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1,973
Location
Selden
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There are situations where both -24 and the same diagnosis are correct per coding guidelines. It is possible the carrier has their own more restrictive policy.
Assuming the -24 was actually warranted, I would submit an appeal letter and the documentation. If the carrier follows Medicare guidelines, I would reference and quote their guidance, specifically whichever scenario applied to this service not being included in the global surgical package. https://www.cms.gov/outreach-and-ed...oducts/downloads/globallsurgery-icn907166.pdf
I never let an incorrect denial not be addressed.
 
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