Surgery in Global Period

LLRodgers

Guru
Messages
152
Best answers
0
Hello,

I have one that is in the 90 day global period for surgery for a meniscal tear. Patient came in for a follow up, they had an effusion, I codded it as followed.

M96.89 - Other post procedural complication and/or disorder of a musculoskeletal system/procedure
M25.462 - effusion
G89.18 - Other Acute Post-procedural Pain
20610-LT-58 - Injection
J1040 - 80 Depo Medrol
99024

This is being denied for post op include in surgery. surgery was for a meniscal tear and he developed an effusion and doctor did an injection. Can anyone tell me if I coded this correct or is this considered pain management due to surgery.

Any help is appreciated.

Thank you,
LLR
 

Orthocoderpgu

True Blue
Local Chapter Officer
Messages
899
Location
Salt Lake City, UT
Best answers
1
The first thing you need to do is look at the insurance being billed. If it is Medicare, or a Medicare policy, they will not pay for complications within a global unless the patient returns to the OR. Private insurance will usually pay for things like this but it is hit and miss. Your modifier -58 is incorrect, that means that your doc KNEW that this would need to be performed after the initial surgery. I would try -78.
 
Messages
1
Location
Belmont, MS
Best answers
0
Modifier 58 is for staged
Modifier 78 is for related
Modifier 79 is for unrelated

I would definitely try the modifier 78. It should pay at a reduced rate.
 
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