Wiki Nancy L

[njlott49]

Nancy L I need help unbundling 55920 from 58200

I have a denied claim from Medicare bundling the procedure into the global charge. A Total Abd Hyst w/para aortic, pelvic lymph was done on 060208 (58200) with the dx of 182.0, 627.1. On 07/31/08 the patient came to the office and had 55920 performed. We billed a 55920.52 & A4648 for that visit. Does anyone know if this is payable in the global period or if we have to write it off? Thanks for your help.

 

[bigredcag]

i would look into modifer 58
52 is reduced services and i bet the dr did the full procedure on the follow up procedure.

 

[thompsonsyl]

Hi,

In order for you to be paid for a procedure done within a global period, you must use the appropriate "post op"-type of modifier. Without knowing the reasons and nature surrounding the procedure done within the post op period, I can't suggest one to you but take a look at: -58, -78, -79.

The -52 modifier you used doesn't allow for procedures to be done within a global period to be considered for payment. Although, it may be correct to use the -52, you will also have to use one of the others.

Hope this helps and Good Luck!