Use Modifiers to Secure Reimbursement for Same-day Postendoscopic Complications
Published on Thu Mar 01, 2001
Patients sometimes develop complications after an endoscopy is performed that requires a second endoscopy or hospitalization. If these complications occur on the same day as the original endoscopy, the gastroenterologist may face some Medicare coding dilemmas. By correctly using modifiers, gastroenterologists and their coders can achieve reimbursement for the hospital admission when Medicare looks askance at reporting an E/M service on the same day as an endoscopy. Further, modifier use will help gastroenterology professionals avoid having Medicare reduce reimbursement for the second endoscopy with the application of its multiple endoscopy or bundling rules.
Service Must Fall Outside the Global Package
Before deciding how to report these encounters and procedures, gastroenterologists must determine whether a postoperative service is separately reportable or a part of the global package for the initial endoscopic procedure. Many postoperative services performed after an endoscopy are not eligible for separate reimbursement. Things like recovery from sedation and checking of vital signs are related to the endoscopic procedure and are part of the global surgical package, says Carol Pohlig, CPC, BSN, RN, a reimbursement analyst for the Hospital of the University of Pennsylvania department of medicine in Philadelphia, where more than 30 gastroenterologists practice.
Another routine postoperative activity not separately billable is time spent in the observation room of an endoscopy suite. For a routine endoscopy done in an outpatient facility, the patient may spend 60 to 90 minutes in observation after the procedure, says Delbert Chumley, MD, a gastroenterologist in San Antonio, and a trustee for the American College of Gastroenterology. Also, the gastroenterologist may talk to the patient about the findings, his or her evaluation and a plan of treatment. This is all part of the global package and considered regular postoperative care.
Postoperative Complications Require Action
Some minor complications that are treatable in the observation room of the endoscopy suite are also part of the global package. If the patient is vomiting in the observation room of the endoscopy suite, you keep him or her in observation until he or she is feeling better, but you dont bill for that, Chumley say. If the patient starts vomiting and goes into shock, then thats above and beyond regular postoperative care.
If the gastroenterologist becomes involved in the medical management of complications that are not part of the routine followup care, he or she is beyond the global surgical package. Once you have identified that the patient has bleeding, fever or infection, and are giving care to those complications, then that medical management is outside of the global package, Pohlig says.
If the gastroenterologist has given orders to put the patient on hydration therapy after developing pancreatitis from an endoscopic retrograde cholangiopancreatography [ERCP], for [...]
