I have a question. A patient was admitted for acute embolism of right femoral vein. I coded a 99223-57 along with a 37211. United Healthcare is denying the claim saying that 99223-57 is in the global period. We have not seen the patient for anything in the last 90 days.
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Resolved Acute Embolism of Right Femoral Vein
- Thread starter KathyP_3146
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Was there any other service provided that day that would be inclusive of this code (admit or another consult or procedure)? Is this for the hospital admit or the surgeon? 37211 is also not a 90-day global code. It has 0 global day period which does not allow a -57 modifier.
UHC does has a same-day policy that I found that states "Contractors pay a physician for only one hospital visit per day for the same patient, whether the problems seen during the encounters are related or not. The inpatient hospital visit descriptors contain the phrase “per day” which means that the code and the payment established for the code represent all services provided on that date. The physician should select a code that reflects all services provided during the date of the service." https://www.uhcprovider.com/content...eimbursement/COMM-Same-Day-Service-Policy.pdf
So my thought would be another E/M charge was also submitted on the same day or to use the -25 modifier instead of -57 since the code included is not a "global service package".
UHC does has a same-day policy that I found that states "Contractors pay a physician for only one hospital visit per day for the same patient, whether the problems seen during the encounters are related or not. The inpatient hospital visit descriptors contain the phrase “per day” which means that the code and the payment established for the code represent all services provided on that date. The physician should select a code that reflects all services provided during the date of the service." https://www.uhcprovider.com/content...eimbursement/COMM-Same-Day-Service-Policy.pdf
So my thought would be another E/M charge was also submitted on the same day or to use the -25 modifier instead of -57 since the code included is not a "global service package".
On this particular visit, I coded 37246-xs-rt, 37211-rt, 99223-57, 75630--26-xs-xu .
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