Question

A patient is seen in the provider's office for a follow-up visit eight days after a procedure. The procedure has a global period of 90 days. The provider submits an E/M code based on documentation of the follow-up visit. The claim is submitted and denied. What is the next step for the biller?

1) Post the denial without adjusting the patient's balance because the denied amount will become the patient's responsibility.
2) Post the denial and notify the patient of the denial.
3) Post the denial and adjust the patient's balance because the follow-up visit is included in the global period.
4) Resubmit the E/M code with modifier -24 to indicate the visit was unrelated to the procedure that was performed eight days ago.

Answer 1

The biller should post the denial and adjust the patient's balance, as the follow-up visit falls under the procedure's 90-day global period and is not separately billable.

Step-by-step explanation:

The next step for the biller after a claim denial for an E/M code submitted for a follow-up visit within the global period of a procedure would be option 3: Post the denial and adjust the patient's balance because the follow-up visit is included in the global period of the procedure. Procedures with a global period typically include all related post-operative care within a specified time frame after the procedure.

In this case, with a 90-day global period, the follow-up visit falls into this timeframe and is not typically separately billable. Therefore, the follow-up visit should generally not be billed to the patient or their insurance separately, and the denied claim does not become the patient's responsibility.