Wiki Global issue 11301 vs 66984

[susie09]

Hello, we have been billing the medicare replacement plan uhc a lesion charge of 11301 and they are deny stating this is global to 66984 cataract removal but yet these were from 2 separate doctors, has anybody ever had any issues regarding this, we have sent appeal after appeal and they are upholding their decision, we have several patients with this issue, any advise would be greatly appreciated.

 

[JesseL]

I'm not experienced with this but maybe it's because both Doctor's are billed under the same group/facility? If that's the case maybe you should use modifier 79.

I'm thinking like if a new patient saw one doctor in a group and then on another day the patient see a different doctor in the same group, that second visit would be considered a established patient, I don't remember where I read this from and not sure if this is true but if it is I think it would apply with this situation.

 

[mitchellde]

These are not even the same location. I assume these providers are also two different specialties? What DX code did you use for the 11301? I am thinking this was not denied for global issue, but rather medical necessity.