Remark code M144 indicates that payment for preoperative and postoperative care is bundled into the overall reimbursement for the surgical or procedural service provided and is not separately payable.
Common causes of code M144 are:
1. The claim includes separate charges for pre-operative or post-operative care when these services are already bundled into the payment for the surgical procedure as per the payer's policy.
2. The provider has incorrectly unbundled the services that should be included in the global surgical package, leading to a denial of the separate charges.
3. There is a misunderstanding or misapplication of the payer's guidelines regarding what constitutes pre-operative and post-operative care within the global surgery period.
4. The billing staff may have used incorrect procedure codes that do not accurately reflect the inclusive nature of the surgical package.
5. The claim was submitted without proper modifiers that differentiate between services that are part of the global surgical package and those that are legitimately billable outside of it.
6. There may be an error in the payer's processing system that incorrectly identified bundled services as separate, resulting in the application of code M144.
7. The surgery or procedure may have been incorrectly coded, leading to the assumption that pre- and post-operative care should be paid separately.
8. The time frame for the global surgical package was not adhered to, with pre- or post-operative services billed outside the designated period covered by the surgery allowance.
Ways to mitigate code M144 include ensuring accurate coding of pre- and post-operative visits. If separate billing is necessary due to exceptional circumstances, provide clear documentation to justify the additional charges. Review the global surgery package rules to understand what is included in the surgery allowance and train staff to recognize services that are separately billable. Regularly audit billing practices to ensure compliance with these guidelines.
The steps to address code M144 involve reviewing the billing documentation to ensure that the services billed separately for pre-operative and post-operative care were not part of the global surgical package. If the services were correctly billed outside of the global package due to exceptional circumstances, provide detailed documentation and a clear explanation to justify the separate charges.
If the services were indeed included in the global surgical package, adjust the billing to remove the separate charges for pre-operative and post-operative care. In the case of incorrect coding, correct the claim and resubmit it with the appropriate codes that reflect the inclusive nature of the surgical package.
Additionally, educate the billing staff to prevent similar issues in future billing cycles.