Go Back   AAPC Medical Coding & Billing Forums > Medical Coding > General Discussion
Forum Rules FAQ Members List Calendar Search Today's Posts Mark Forums Read

Reply
 
Thread Tools
  #1  
Old 03-14-2011, 02:48 PM
LaSeille LaSeille is offline
Networker
 
Join Date: Apr 2007
Posts: 84
LaSeille is on a distinguished road
Default global period BEFORE surgery???

Please help! SCENARIO: Patient is seen in surgeon's office for an office visit, and the surgeon decides that the patient needs surgery.

It is my understanding that if the surgery is to be performed the same day or the next day, modifer 57 should be added to the office visit code in order to receive payment for both the office visit AND the surgery. However, if the surgery is done two days after the office visit, then no modifier is needed.

First, is my assumption correct?

Second, is anyone aware of any insurance carriers that have a specific "pre-surgery global period"??

We received two denied claims (two different carriers) for office visits that were performed two days before surgery and both EOB's stated that the office visit was inclusive with the surgery.

Thanks for any insight to this matter.
Reply With Quote
  #2  
Old 03-14-2011, 03:09 PM
btadlock1's Avatar
btadlock1 btadlock1 is offline
True Blue
 
Join Date: Apr 2007
Location: Lubbock, TX
Posts: 1,505
btadlock1 will become famous soon enough
Wink

Quote:
Originally Posted by LaSeille View Post
Please help! SCENARIO: Patient is seen in surgeon's office for an office visit, and the surgeon decides that the patient needs surgery.

It is my understanding that if the surgery is to be performed the same day or the next day, modifer 57 should be added to the office visit code in order to receive payment for both the office visit AND the surgery. However, if the surgery is done two days after the office visit, then no modifier is needed.

First, is my assumption correct?

Second, is anyone aware of any insurance carriers that have a specific "pre-surgery global period"??

We received two denied claims (two different carriers) for office visits that were performed two days before surgery and both EOB's stated that the office visit was inclusive with the surgery.

Thanks for any insight to this matter.
You add the 57 modifier, even if the surgery has been scheduled more then one day after the E/M where the decision for surgery was made. This allows payers to differentiate between a pre-op clearance visit (which is global) and the visit that led to the procedure. You would not add a 25 modifier to any other (unrelated) visits between the decision for surgery and the surgery, but you might have to send office notes to show that the said visits were separate and not related to the surgery. You can't bill for the pre-op clearance, though. I hope I explained that in a way that didn't make it more confusing!

Let me know if you have any other questions, though...
__________________
Brandi Tadlock, CPC, CPC-P, CPMA, CPCO
Reply With Quote
Reply

Thread Tools

Posting Rules
You may not post new threads
You may not post replies
You may not post attachments
You may not edit your posts

BB code is On
Smilies are On
[IMG] code is On
HTML code is Off




Disclaimer: Although AAPC staff members will monitor these forums periodically, we cannot be responsible for the information posted herein, nor guarantee its accuracy. Our members may discuss various subjects related to medical coding, but none of the information should replace the independent judgment of a physician for any given health issue. Please note that the opinions expressed here do not necessarily reflect those of AAPC.

All times are GMT -6. The time now is 05:52 AM.

AAPC - Top

Powered by vBulletin® Version 3.8.1
Copyright ©2000 - 2014, Jelsoft Enterprises Ltd.
Copyright ©2014, AAPC