tayloram
New
Good morning, I keep getting denials and need some guidance! 99212 11200 on dates of service 06/29, 07/08, 07/13 Please help with modifiers!
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Wiki Global Period Question
- Thread starter tayloram
- Start date
thomas7331
Guest
Assignment of modifiers will be based on documentation. If you are billing 11200 on all of these dates, then the visits on 7/8 and 7/13 will both fall into the 10-day global period of the prior service. Given this, a 99212 on those dates would require modifiers 24 and 25 if the documentation supports that the service billed with 99212 is both separately identifiable from the procedure performed that day, and also unrelated the procedure on the prior date. The procedure 11200 itself on those two dates would require either modifier 58, 78 or 79, as appropriate based on the documentation. If none of these modifiers is supported by documentation, then the service would be considered inclusive in the global package and should not be billed.
Orthocoderpgu
True Blue
I totally agree with Thomas here. Something to keep in mind is that every surgical procedure, no matter now small, has a basic E/M built into it. For 11200, how much mental thought is needed to decide that the tags need to be removed? Tags are not normally removed unless they are in an anatomical area where they can get caught on something and pulled. Otherwise they are benign and usually don't cause any issues and can go away on their own.
SharonCollachi
Guest
I have to wonder why there were 3 sessions so close together. In 9 days and then in 5 days, did a huge new crop of skin tags pop up in a painful area that required removal???
What it looks like, "on paper", is that the doctor spread the removal out to three sessions to maximize reimbursement. I am NOT saying that's what they did, I'm saying that's what it LOOKS like, without further information, and I'm pretty certain that's what it looks like to the insurance company as well. If the documentation doesn't show the medical necessity of the three sessions, you might as well write off the 2nd two sessions, educate the provider, and call it a day.
What it looks like, "on paper", is that the doctor spread the removal out to three sessions to maximize reimbursement. I am NOT saying that's what they did, I'm saying that's what it LOOKS like, without further information, and I'm pretty certain that's what it looks like to the insurance company as well. If the documentation doesn't show the medical necessity of the three sessions, you might as well write off the 2nd two sessions, educate the provider, and call it a day.