Wiki 50590 with 52332 and 52353 19 days later

Create Wiki
B

bill2doc

Guest
Messages
455
Best answers
0
Hi,

Dr performed 50590, 19 days later 52332 and 52353....tried to bill but got denied for the 52332/52353 for global. I don't see 52353 w/ 50590 and a code 9 for the 52332...Need help to understand if these both fall under the global of 50590 or if there is a mod I can use ???

Thanks
 
CPT 50590 has 90 global days so any procedures performed during this period will need modifiers. If CPT 52332 & 52353 are related to the ESWL (which they probably are) add a 58 modifier to each code.
 
50590 and 52332, insurance denied 52332 as global

Dr performed 50590 and 52332, insurance denied 52332 as global, can you please advise on how to proceed., is there a modifier that can be amended to 52332?
 
The global period modifiers for surgical procedures are 58, 78 and 79. If the documentation supports any one of these, then you should be able to use them to get payment. If not, then the denial was appropriate.
 
58 Modifier if additional surgery (CPT 52332) was planned to be done at time of original surgery (50590).

78 Modifier if additional surgery (CPT 52332) was not planned to be done at time of the original (50590).

79 Modifier is additional surgery (CPT 52332) unrelated to the original surgery (50590). Example 50590 was done on the right side then bill with 52332 for the left side: 52332 then modifier 79 and LT.

Remember 58, 78, and 79 modifier would be the first modifier then followed by the RT or LT modifier.
 
TammyHF said:
58 Modifier if additional surgery (CPT 52332) was planned to be done at time of original surgery (50590).

78 Modifier if additional surgery (CPT 52332) was not planned to be done at time of the original (50590).

79 Modifier is additional surgery (CPT 52332) unrelated to the original surgery (50590). Example 50590 was done on the right side then bill with 52332 for the left side: 52332 then modifier 79 and LT.

Remember 58, 78, and 79 modifier would be the first modifier then followed by the RT or LT modifier.
Click to expand...
So, what about for an encounter where 52356 was done during the global period of the 50590 for persistent 7 mm RT UPJ calculi. Original procedure done 11/18 for RT renal calculi, next procedure done 1/26/2021. I am presuming modifier 78 since it was not original planned at the time of the original surgery and seems related to me to the original procedure.
 
This clinical scenario sounds like a treatment of a complication of the ESWL. Therefore, the correct modifier would be -78.
Michael A. Ferragamo MD, FACS
 
You must log in or register to reply here.
Top