Forum - Questions & Answers
modifiers
I have a claim denied for part of global service. Pt. saw different Dr. for post op same day his primary care Dr. Post op 99024 (440.21) Primary care 99212 (272.4, 429.2) what modifier can I use to get claim to process successfully?
Ruth
re: modifiers
So, you have related diagnosis but the primary (what specialty?) saw on same day as surgeon (Cardiologist?). If the second doctor (same practice/different specialty) is seeing patient for the underlying condition and has a medical necessity for the encounter, you do not need a modifier. If they are both cardiologist, for example, in same practice, you will have to appeal the denial. One doing post-op and anything related to recovery from procedure in global period and the other treating for example, ASHD, underlying condition. The second doctor, different specialty is easier because the condition is not related to recovery from procedure. The problem comes if both same practice/same specialty.