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Modifier 24 but different physician???

  1. #11
    Default Same diagnosis
    Medical Coding Books
    If you are using the same diagnosis as the surgeron then medicaid will deny those visit's as global regardless of billed the visits. We have this problem with oncology. We will see a patient and refer them to general surgery for a line placement for chemo and all our visit's are denied because we both billed with the neoplasm diagnosis. No way around this unless there is another diagnosis which for oncology there isn't.

  2. #12
    Location
    Milwaukee WI
    Posts
    4,466
    Default Can't bill Medicaid Patient
    At least in Wisconsin you cannot bill the Medicaid patient directly for services that are denied due to global (or no auth, or the Medicaid fairy was having a bad day).

    Good luck.

    F Tessa Bartels, CPC, CEMC

  3. #13
    Location
    Hendersonville, NC
    Posts
    14
    Default
    I have a similar issue with NC Medicaid. They will deny for global when a patient has a procedure done at another hospital by a completely different physician group, and when seen by our physician at his local hospital for complications...all of our visits are denied. Has anyone had any luck appealing these issues?

  4. #14
    Location
    Hendersonville, NC
    Posts
    14
    Default
    [QUOTE=jkirasich;126227]I have a similar issue with NC Medicaid. They will deny for global when a patient has a procedure done at another hospital by a completely different physician group, and when seen by our physician at his local hospital for complications...all of our visits are denied. Has anyone had any luck appealing these issues?[/QUOTE

    FYI: I have also been told by Medicaid that we need to append modifier 24. I was told that per their guidelines, modifier 24 can be used with a different provider if the same specialty as the provider who performed the global service.

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