Updated: Evaluation and Management Services Denied in Global Period of Surgery Performed by Another Surgeon
States Applicable to Alert: Southern California
Background Information: Due to an incorrect indicator entered into the Southern California system, some evaluation and management services (visits or consults) provided from January 1, 2009 to February 13, 2009 under the following conditions were denied in error
- A major surgery was performed from January 1, 2009 to February 13, 2009 by another provider on the same patient
- The visit/consult occurred before, during or after the day of the major surgery
Applies To Procedure Code: Evaluation and Management Services (visits and consults)
Remark /Reason Codes:
97 - The benefit for this service is included in the payment/allowance for another service/ procedure that has already been adjudicated.
M144 - Pre- or post-operative care payment is included in the allowance for the surgery/procedure.
MAC Action: The system was corrected on February 13, 2009. A mass adjustment will be performed to correct the claims denied in error. A mass adjustment was completed on May 1, 2009.
Provider Action: No Action Required
Date Reported: February 13, 2009
Date Resolved: May 1, 2009