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tci ED Coding & Reimbursement Alert - 2004 Issue 7

Reader Question: Don't Let 2nd Service Wrap Into Global Care

Question: I received a denial from Medicare for a patient who had two hip dislocation reductions performed about 60 days apart. I used modifier -54 on both, but the second visit keeps getting denied because Medicare states that the physician performed it during the global period for the initial procedure. Are there any other modifiers I should use to justify this work? Alabama SubscriberAnswer: Instead of appending modifier -54 (Surgical care only), you should consider using modifier -59 (Distinct procedural service) to identify the second reduction as a distinct procedural service. The second reduction is really the result of...

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