lcomfort
Guest
I have a pt who has United Healthcare and had an inpt consult (99253) for a hand abscess on 11-4-07. This is the first time the patient was ever seen by Dr. at Cornerstone Surgical. Dr was able to express some pus from his hand at this visit, however he decided that further drainage of the abscess was needed. He did that on 11-5-07 (proc 10061). The consult was denied as included in global/pre-op. I can't use a 25 modifier because the surgery wasn't on the same day as the consult (the pt had eaten breakfast so he had to wait til next day). I can't use a 57 modifier because this is a 10 day global and 57 modifiers can only be used on 90 day global surgeries. So, is there anything I can do to get the consult paid? The doctor tried expressing pus from his hand at the consult but it still needing addl draining, thus the decision for surgery.
Since I can't attach a modifier, can I appeal w/ the consult notes which indicate the dr expressing pus from his hand at the consult, and the notes also indicate that the pt's hand needs further draining and surgery would be done next day because he at breakfast; or does this consult have to be written off as global since the diagnosis for the consult and surgery are both the same.
Since I can't attach a modifier, can I appeal w/ the consult notes which indicate the dr expressing pus from his hand at the consult, and the notes also indicate that the pt's hand needs further draining and surgery would be done next day because he at breakfast; or does this consult have to be written off as global since the diagnosis for the consult and surgery are both the same.