Wiki CMS Guidelines for Modifier 24 Being Used During A Global Period

[cnorthcutt343]

Hi, I have a question about resources pertaining to the policy guidelines for the use of modifier 24 during a global period when a different specialist is involved. I work for a pain management office. I came across a claim that denied because a pain management provider saw a patient during a global period for a neurologist performing a Stim procedure. My question is how can I prove to insurance that this was appropriately billed? Am I correct in thinking that even if a different specialist share the same tax ID, that they can still bill separate from a surgical global period? Any advice is helpful. Thanks in advance!

 

[csperoni]

Even in the same group, a different specialty is not included in the global surgical package.
From the CMS Global Surgery booklet: (one of my favorite references)
The global surgical package, also called global surgery, includes all necessary services normally provided by a provider (or members of the same group with the same specialty) before, during, and after a procedure. Providers in the same group practice, with the same specialty, must bill and accept payment as though they’re a single physician.

 

[cnorthcutt343]

Thank you!