Wiki BCBS TX nonpayment of E/M with modifier 24

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eminey

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Liberty Hill, TX
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Tubes and adenoids are performed. Pt comes in 30 days later and has audio. Doctor codes 99213, 92557, 92550. Modifier 24 is on OV. Diagnosis is only for the ears. No adenoids mentioned. BCBS is refusing payment for office visit, saying it's within global. Not sure what is wrong here. Help! Thanks!
 
You might want to find out what BCBS has for global days for tubes. Just because it is 10 days for Medicare, does not mean that BCBS has the same short global period.

If the patient is still in the BCBS global, diagnostic tests are still Payable. So the audiology that was performed is still billable and payable. This is similar to orthopedics being paid for x-rays of fractures during the global


Barbara J. Cobuzzi MBA, CPC, COC, CPC-P CPC-I CPCO, CENTC
Consulting Editor Otolaryngology Coding Alert
www.CRNHealthcare.com
b.cobuzzi@att.net
 
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