Nancy L I need help unbundling 55920 from 58200
I have a denied claim from Medicare bundling the procedure into the global charge. A Total Abd Hyst w/para aortic, pelvic lymph was done on 060208 (58200) with the dx of 182.0, 627.1. On 07/31/08 the patient came to the office and had 55920 performed. We billed a 55920.52 & A4648 for that visit. Does anyone know if this is payable in the global period or if we have to write it off? Thanks for your help.
Last edited by njlott49; 08-13-2008 at 01:34 PM.
Reason: No one knows what it is about
i would look into modifer 58
52 is reduced services and i bet the dr did the full procedure on the follow up procedure.
In order for you to be paid for a procedure done within a global period, you must use the appropriate "post op"-type of modifier. Without knowing the reasons and nature surrounding the procedure done within the post op period, I can't suggest one to you but take a look at: -58, -78, -79.
The -52 modifier you used doesn't allow for procedures to be done within a global period to be considered for payment. Although, it may be correct to use the -52, you will also have to use one of the others.
Hope this helps and Good Luck!
Last edited by thompsonsyl; 09-02-2008 at 09:27 PM.
Sylvia Thompson, CPC
San Diego, CA