20610 and 24-hour global

Does anyone have the documentation for this?

Comments

  • edited May 2017
    According to CMS, 20610 has no global days.
  • We have a denial from UHC stating that it has a 24-hour global. It may depend on the carrier. I have seen it before with a 24-hour global but I cannot remember where.

    I am in Nebraska and BCBS is now wanting documentation for all 24 and 59 usage. I agree with this. We have, even in my office, an abuse of these two modifiers.

    This particular case the doc had looked at two different body parts so we were curious as to why UHC had still denied it for being global.
  • edited May 2017
    Pam,

    What other codes were billed in addition to 20610?
  • The office visit- 99213
  • edited May 2017
    CPT and CMS  have both stated that some minor procedures have zero global days, but even those minor procedures have THAT day as part of their package,  thus the need for modifier 25 or 59 in certain situations and depending on the services .  Also the CCI edits only apply to that SAME day, but a modifier can be used such as different session,  etc.
    So if an injection is given at 9am, and later in the day the patient has another service if the injection is not protected with a modifier it could get bundled into the other services.  
  • edited May 2017
    Was the modifier 25 attached to 99213? If the E/M code met the requirements for a separate, identifiable service you may have to appeal with the office notes. We have ran across a smattering of insurance companies that deny the E/M even if the modifier 25 is attached. I'm not sure if that has happened with UHC, but if has happened with Humana. It seems more and more insurance companies are coming up with their own reimbursement guidelines that don't follow CCI or CPT.
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