Wiki humana 31237-79

[freespririt0806]

we are having a terrible time lately with post op debridements 31237-79, they are denying stating not payable within the global, some of our claims are being chg to 58 (which i know is incorrect if 31237 is done for sinus as FESS codes have no global) and Humana is denying those, anyone having this issue
It is maddening !

 

[nlaaron]

Sounds to me like you are saying that 31237-79 is being billed after a FESS code which does NOT have a global period. If you are billing 31237-79 when there is not a previous procedure found paid in history with a 10 or 90 day global, within either 10 days of a 10 day procedure or within 90 days of a 90 days procedure, 31237-79 will deny because modifier 79 is only applicable when the service is rendered in a 10 or 90 days global period, and it is inappropriate to bill for a related service or previously scheduled service. Hope this helps.
https://www.codingahead.com/modifier-79-description-uses-guidelines-examples/

 

[Sbaysinger]

We too are having a hard time getting Humana to pay 31237-79 after sinus surgery & septoplasty. We too, are getting a denial that it is included in the global period (septoplasty has 90 days). We append modifier 79 to indicate that it is unrelated to the procedure that has the global period, but are not having luck with our reconsiderations and/or appeals. Does anyone have any insight on this or know where we can find additional resources for support? Thanks!