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tricare incorrectly applying global period to injections

  1. Default tricare incorrectly applying global period to injections
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    Tricare is denying office visits as global to injections (code 64490,27096) stating that claimcheck says there is a 90 day global on these procedures. Medicare shows a global of 0. Has anyone else seen this or have any suggestions?

  2. #2
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    Baton Rouge
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    Quote Originally Posted by kwieszek View Post
    Tricare is denying office visits as global to injections (code 64490,27096) stating that claimcheck says there is a 90 day global on these procedures. Medicare shows a global of 0. Has anyone else seen this or have any suggestions?
    I haven't had this problem, but I do know that some carriers set their own global periods instead of following Medicare guidelines. Either way, they need to put it in writing so that providers can be aware of how to code correctly for aftercare
    Meagan Strauss, CPC, CEMC
    Coding Coordinator
    The NeuroMedical Center
    Baton Rouge, LA

  3. Default
    Since Tricare is a government policy, they should file Medicare guidelines. I would file an appeal with a print out of the code on Medicare's website showing that the code has a 0 day global and ask them to reconsider. In your appeal letter, I might also put in there why the code should not have a global. For example, patient comes only for injection, usually not much follow up and it doesnt warrant a 90 day global for the procedure. I would also put in the letter that the global is taken in consideration when a code is valued, a code with 0 global is going to have a lower reimbursement than a code with 90 day global.

  4. #4
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    Quote Originally Posted by penguins11 View Post
    Since Tricare is a government policy, they should file Medicare guidelines. I would file an appeal with a print out of the code on Medicare's website showing that the code has a 0 day global and ask them to reconsider. In your appeal letter, I might also put in there why the code should not have a global. For example, patient comes only for injection, usually not much follow up and it doesnt warrant a 90 day global for the procedure. I would also put in the letter that the global is taken in consideration when a code is valued, a code with 0 global is going to have a lower reimbursement than a code with 90 day global.
    I would go to the Tricare website and check it out. You may also need to append a modifier even if there is not a global period.
    Arlene J. Smith, CPC, CPMA, CEMC, COBGC

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