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help!

  1. Default help!
    Medical Coding Books
    I have a dr who was pre-admitting a pt for a c-section because of being breech. When the pt came in that day she was no longer breech so her c-section was cancelled. Over a week later she came in and was having a different problem and had to have a c-section. My dr wants to charge something for the day she came to the hospital and they cancelled her. I told him there was nothing to bill as this is during the global package. Is there something that I can bill for?

    Tracey

  2. #2
    Location
    Connecticut
    Posts
    26
    Default
    The encounter can be billed because the service is not part of routine prenatal care and therefore falls outside of the global package. Code for the E/M according to the hospital note with a -24 and 652.13.

  3. Default
    24 mod is used when during the postop period which she didn't deliver yet so I wouldn't be able to use that modifier. If I try to bill an e/m code it will be rejected by the insurance saying this is during the prenatal care.

  4. #4
    Default Complications are not part of global fee.
    You can bill this E&M. Complications are not part of the global surgical package. No real modifier applies, so submit a paper claim and a letter with notes from that service explaining the situation. It will probably go for pre-payment review and get approved. If it gets rejected, appeal with the same info. You should get a positive response eventually.

    ************
    PB

  5. #5
    Location
    Connecticut
    Posts
    26
    Default
    Yes, you should use modifier 24. The terms "Global Period" and "Postoperative Period" are synonymous. If you use the -24 on the E/M code the claim should not be denied. If the claim is denied it sould be appealed, as the service is payable because the codes for Global prenatal care only include routine services.

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