Wiki Appeal advice!!

[TJAlexander]

I need some advice to appeal a denial for an office visit during a patient's global period. The patient received MMT surgery on 7/24/19. The global period end date is 10/24/19. She came in for her final post-op appointment on 10/17 but during the appointment she was evaluated for an unrelated problem; foot pain. The patient was previously seen for a sprained ankle in May 2019 but the patient indicated she was still having foot pain. I submitted the claim as:

99214-24
Dx code: M76.821

The payer denied the claim for the following reason:

CO261: The procedure or service is inconsistent with the patient's history.

I don't even know where to begin to appeal the denial. What does this denial even mean?

 

[lburgos31]

I am not sure what the MMT surgery acronym means .. for some reason im thing Medial Menisectomy? Correct me if I am wrong. You stated the patient had foot pain in the unrelated portion of the visit. DX code: m76.821 is in a family of codes that excludes the foot. Posterior= closer to the point of origin which means closer to knee. Tibia is connected to knee. Maybe a better diagnosis would help get your claim processed.

 

[TJAlexander]

SMH!

I am not sure what the MMT surgery acronym means .. for some reason im thing Medial Menisectomy? Correct me if I am wrong. You stated the patient had foot pain in the unrelated portion of the visit. DX code: m76.821 is in a family of codes that excludes the foot. Posterior= closer to the point of origin which means closer to knee. Tibia is connected to knee. Maybe a better diagnosis would help get your claim processed.

View attachment 4331

SMH! Wow, it was staring me right in the face, thank you for your help lburgos31!!