Wiki Global period confusion

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eleciah83

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One of my surgeons performed I&D of an abscess in the office (pt's first visit). The pt was seen twice within the 10 day global period which I did not charge for, and once outside the global period which I did charge for. Now the original office visit (the I&D) is being denied due to no pre-auth. My office manager is wanting me to ignore the I&D (knowing that we aren't going to get paid for it) and wants me to code for the two office visits I didn't originally charge for. I'm not feeling comfortable about charging for these visits as they clearly state the pt is here for a postop I&D recheck and nothing else is being addressed. Thoughts???
 
You did not pre auth the procedure? That is your bad then, you cannot charge for the services the patient is entitled to as a part of the surgical package. Just because things did not work out the way you thought it would does not mean you can go back and pretend the surgery never happened.
 
That's exactly how I feel. I was just looking for reinforcement. As a side note, I'm not responsible for getting the pre-certs for our office. That is unrelated to myself. I was just making sure I'm legitimately refusing to charge for those global period visits. Thank you for your input.
 
I agree, however I would try to appeal the I&D with a letter stating that you had no idea the patient was going to have this done. Did you bill an E/M with mod 25? Did that get paid? Im assuming the chief complaint was abscess but in your defense, you didn't know what the physician was going to do. Some insurances may pay due to it being a spontaneous decision to perform the I&D. Just another way of looking at it. I wouldnt just write it off.. I would at least try to obtain reimbursement.

Hope this helps :)
 
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