Wiki Federal BC & Global Periods

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Is anyone else getting denials for services being "global" when the provider didn't do the surgery? We are a multi-specialty practice under one TIN. Our ENT performed a tonsillectomy and then the pt saw a family practitioner for a gyn complaint. They denied the gyn office visit and the rep states it's "bundled" into the surgery since it was within the 90 days. She said that a modifier may work. Obviously -24 would get around this but this has never happened before and we have more than one denial. Have the rules changed? Do I have to check the pt's whole account every time to see if any other specialty billed something that has a global period to it?
 
Yes since they are under the same tax id then it will be denied. And I would use a -24 if the patient is being seen for an unrelated problem. We would have to check the patients chart for globals before we billed. But we were able to do an alert in our system that this patient has a 90 day global for (and put the reason or dx), so we didn't have to look back. Hope this helps!

Jessica Harrell, CPC
 
Different specialties

Actually, even if they are in the same practice (i.e. same tax ID), if they are of different specialties AND PROPERLY CREDENTIALED WITH THE PAYER, the GYN visit should not be global to the T&A.

Check to be sure the family practice physician's and the ENT surgeon's credentials use the correct taxonomy codes. You should not need a modifier when two different specialists are involved (for clearly completely different issues).

Hope that helps.

F Tessa Bartels, CPC, CEMC
 
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You may want to be careful appending modifier -24 based on the definition unrelated evaluation and management service by same physician during a postoperative period. Hence same physician. We are receiving denials also for the same issue in our practice. You may want to check how the physician is credential ensuring they are not under the same specialty and appeal as two different provider seeing the patient for different diagnosis with supporting documentation.
 
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