I have a question an Iowa Medicare Denial. The patient came into the ER with a dislodged feeding tube- I billed out the E/R visit for it. Then, that evening, he came back and the physician did mild dilation of gastrostomy tract and gastrostomy tube re-insertion. I billed out for the procedures that time and put a 25 modifier on the E/R visit from that morning. Medicare is denying for the procedure codes. Is this correct and that I can't bill for the procedures even though the E/R visit and the procedures were 12 hrs apart?
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Wiki E/M Modifier w/Surgery
- Thread starter BABS37
- Start date
Sounds like the patient is in a Global. If that's the case you won't be able to charge for the E/R visit if your Dr/Group of same specialty see's the patient unless you can justify modifier -24 as unrelated to global. The dilation/re-insertion won't be billable unless it was done in the OR or a certified procedure room. If it was, you will use -78 on the procedure and -24 & -25 (if justified) on the E/M. If not done in OR, it will be considered part of the global.