Wiki Modifier-exam under anesthesia

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MSUEEMBRY

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My doctor did a rectal exam under anesthesia CPT 45990, This patient had a prior hemorrhoid surgical procedure that has a 90 day global period and is still in the surgical global period. What modifier should I use on the CPT 45990 exam under anesthesia.

Insurance has denied with modifier 78 (return to OR for related procedure during postop period) Modifier 79 does not fit because this exam was related to the original procedure. Modifier 24 only works on E/M codes..

Any help is appreciated.
 
What's the diagnosis being used on the claim. Post-op complications? The modifier your using seems correct regardless.

If the exam was just a follow-up procedure then it shouldn't be reimbursed since it's in the global period.
 
45990

Diagnosis is 998.11, patient was having complications. this is Humana CareSource Medicaid and I think they make up the rules as they go along.

I tried using modifier 79, that one was also denied.
 
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