Wiki Return to hospital after procedure

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JCampbell

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A patient presented to our hospital for a procedure (46614, anoscopy w/ control of bleeding) on 5/15/13. This was an unplanned return to the operating room from procedure that was previously done on 5-7-13. The patient's surgeon followed up with him on the following two days. Medicare is denying stating that this is included in with another service. I am assuming that they are bundling with the procedure.

Can someone tell me if this is correct?

Thanks in advance for any help that you may be able to provide!
Jennifer
 
I would think the problem is with the 46930 which has a 90 day global. Did you try submitting 46614 with a 78 modifier ? This would indicate to medicare that it was an Unplanned Return to the Operating/Procedure Room by the Same Physician or Other Qualified Health Care Professional Following Initial Procedure for a Related Procedure During the Postoperative Period.

Debbie CPC, CGSG
 
We did submit 46614 with a 78 modifier but Medicare does not want to pay for 5/16/13 and 5/17/13 observation follow up visits. Would these be bundled in with cpt code 46614?

I did not see where this has had a global period.

Thanks,
Jennifer
 
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