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Our office was treating a pregnant patient and she has left the practice. We are trying to bill the appropriate E & M code but they rejected stating "global period". Does anyone know what modifier to use? Thanks!
You don't need a modifier, but you do need to appeal the decision to the insurance company. In the appeal state how many times the patient was seen and you are not billing for the global period as the patient left the practice. You may need to send the office notes.
It is weird that you would get a global rejection if you did not bill any antenatal or delivery codes. If the patient was seen more than 3 times, I would use 59425-6 only. Any other visits unrelated to management of pregnancy would need a 24 modifier.
I have always been led to believe that the first three visits are included in the 59425...is this incorrect? You could read the cpt book either way now that I look at it that way???
I you look in the CPT book under the exclusions for 59425-59430, it excludes antepartum care 1-3 visits (99201-99499). So, you need to bill out the first three visits.
Pt was seen 4 times, you would bill 59425. The CPT book states whether they have 1,2 or 3 visits you would bill the proper E/M code anything after you would either bill the 59425/59426 (depending on the total # of visits).