Wiki RPM denied as included if used during a global postoperative period

[kathleenpotts]

Has anyone found specific modifiers to be successful in avoiding this denial for RPM Services in a postoperative period? Codes typically being used are 99453, 99454, 99458, 99458, 99091. We wondered if a -79 or perhaps -33 would work? (my concern with -79 is it isn't a hospital outpatient procedure for the clinic) Also, to clarify, the start of RPM services is at least 1 day prior to the surgical procedure typically and is not billed until completion 30 days after.

 

[jkyles]

Hi there, those are E/M codes. If the RPM service is not related to the procedure you'd report it with the appropriate E/M modifier.

 

[kathleenpotts]

Thank you, yes, that is why we were thinking to use the -33 modifier. Do you have a better suggestion so the insurance doesn't try to lump it in with the surgical procedure during the same period of time?

 

[thomas7331]

Modifier 33 identifies the code as a preventive service - I don't think it's going to get the code paid if it's denied as part of the global period. The only modifiers used for this purpose are 24, 58, 78 and 79. Since your codes are not surgical procedures, 58, 78 and 79 are not appropriate. If your service is unrelated to the surgical procedure and your documentation clearly supports this, I think 24 is your only choice.