03/29/2024

Global Denial for 20670 After Previously Billing 28505

Provider billed CPT 28505 with diagnosis S92.411A One month later provider removed pin and billed code 20670. Of course the 20670 was denied for being billed in global period. Question-is this code not payable because it's a follow up and part of the original procedure or can the provider get paid for this and there's a modifier that's appropriate to append?

CPT 20670 will normally be inclusive within the payment for CPT 28505. It cannot be unbundled under normal circumstances if the patient has no complications from the procedure. However, if the patient does have complications within the 90 global period where new conditions emerge, that would allow for separate payment to be made. In those limited circumstances, CPT 20670 can be billed with modifier -78 to be reimbursed for the implant removal. Progress notes or op-reports need to clearly outline complications from the surgical procedure to justify proper use of the modifier.