Document Transfer of Care to Get Paid for Post-op Work
Trick question: How many days long is the Medicare 90-day global period? The surprising answer is 92.
“Count 1 day before the day of the surgery, the day of surgery, and the 90 days immediately following the day of surgery,” advises the Medicare Learning Network “Global Surgery Fact Sheet.” Bundled services within that 92-day period include:
• Pre-operative visits after the decision is made to operate, including pre-operative visits the day before the day of surgery
• Intra-operative services that are a usual and necessary part of a surgical procedure
• All medical or surgical services required of the surgeon during the post-operative period due to complications that do not require additional trips to the operating room
• Follow-up visits related to recovery from the surgery
• Post-surgical pain management by the surgeon
• Supplies, except for those identified as exclusions
• Miscellaneous services (e.g., dressing changes, removal of sutures, staples, casts, etc.)
Separate billing is not allowed for visits or other services that are included in the global package.
How is payment divided if two physicians split the work of the global period (for instance, one physician performs the operation and a second physician provides post-op care)? The answer depends on the relationship of the two physicians.
Per Medicare policy, physicians in the same group practice who are in the same specialty must bill and be paid as though they are one physician. When these conditions aren’t met, payment for the post-operative, post-discharge care is split between the two physicians—as long as they agree on the transfer of care. Both physicians must keep a copy of the written transfer agreement in the beneficiary’s medical record.
When there is no transfer of care, services of a physician other than the surgeon may be reported with the appropriate level E/M code. Medicare will separately reimburse properly documented, medically necessary services.