Author Topic: How do I get claim paid when denied for global service?  (Read 6271 times)

Alice Scott

  • Global Moderator
  • Full Member
  • *****
  • Posts: 209
    • Solutions Medical Billing
How do I get claim paid when denied for global service?
« on: March 31, 2008, 05:04:20 PM »
Question
Hi,
I'm new on the billing job. I've received a few denied claims on E/M code
99213, and the remark for it is: The procedure or supply is part of the
global service. These charges are not eligible for separate reimbursement.
But it is 99213 for office visit. What do I do to get reimburse from
carrier? Thanks a lot.
?
P.L. in CA

Answer
HI PL,
You must be billing other codes on the claim, or the visit is during a
post operative period. If there are other services on the claim, they are
saying that the 99213 is part of the other service. If the patient had a
surgical procedure, they are saying that the office visit falls within the
period for post operative care.

Thanks
Michele

Response
Wow! Thank you so much forctually replying my email.
?
I'm in chiropractor's office. Most of claims are billing for 99213, 97140, 97110, 97112, and/or 98940~3. They often deny 99213 and 97110. I got very frustrated by this. 99213 is for brief or more exams for patients' each visit to see if they need different treatments or keep doing what seems works for them. How do I bill it and actually get paid? Do I need to add modifier -25 or some sort?
?
Thanks again for replying promptly.
?
Best Regards,
PL in CA

Answer
HI PL,
   You can add a 25 modifier to the 99213, which means that there is a distinct separate reason for the office visit code from the other codes being billed.  This may or may not help, since many insurance plans either have a global allowance for chiros, or they only allow chiros to bill certain cpt codes (ie manipulation codes).

Good luck
Michele
Sign Up for our FREE Medical Billing Newsletter
Get a 10% discount on Medical Billing Products by using Coupon Code: 10OFF
http://www.solutions-medical-billing.com

MBP

  • Jr. Member
  • **
  • Posts: 85
Re: How do I get claim paid when denied for global service?
« Reply #1 on: September 23, 2009, 12:22:03 PM »
Can someone help me with how to bill for woundcare, i've searched entire forum and only found answers to post op visits - outpatient (article about suture removal). i work for a general surgeon and this happens quite often - she get called to the ER to do a consult (we bill 99254), then she sees this patient again in the hospital (99232), she does a surgery (lets say sx with global 90 days) and after that she sees this patient again daily (99232) and then discharges (99238). she does woundcare for the patient after the surgery, with diabetics or patients with difficult healing wounds it is more then a regular post op follow up. Patients stay in the hospital sometimes for days or weeks after the sx she performs due to complications with the wound or because they are still sick.. is there a way to bill for these daily rounds during post op period and actually get paid?? i'm frustrated i've searched for an answer, but one doesnt know where to look anymore, there is so much info out there  ???

Priyan

  • Newbie
  • *
  • Posts: 31
Re: How do I get claim paid when denied for global service?
« Reply #2 on: October 03, 2009, 03:45:32 AM »
Erika:

    Yes, we can even get paid for the Diabetic wound care service when even considered under global period.

   Senario is this: Even when General surgeon have did a surgery and doing follow up services.

When Diabetic wound is not releven to the surgery performed or with the follow up of the PT.

We need to report Wound care service with sx, 250.80 - 250.83 as supporting diagnosis and with Ulcer diagnosis. Should also report with Modifier 59. This will make insurance to realise that Wound care is not related to the surgery or the follow up on billing.

THanks
Priyan.D
Priyan.D
Pleasure in Job, brings Perfection in work