Neurosurgery Coding Alert

What should you do when your physician treats a patient during the global period of a procedure performed by another surgeon in your practice? If you think payers dictate that you must "write off" such visits, you're missing out on deserved reimbursement, particularly if a physician of another specialty within your practice sees the patient for a separate procedure. Use Modifiers to Separate Surgeries Because surgeons in a group practice typically share the same tax identification number, Medicare considers them the "same" physician for billing purposes. This means that you may be unable to bill for subsequent surgeries during a global period for surgeons of the same specialty, unless you use modifiers correctly to indicate the independent nature of the procedures.

For instance, Dr. Jones performs spinal repair 63056 (Transpedicular approach with decompression of spinal cord, equina and/or nerve root[s] [e.g., herniated intervertebral disk], single segment; lumbar [including transfacet, or lateral extraforaminal approach] [e.g., far lateral herniated intervertebral disk]) on a 48-year-old male patient. Nine weeks later, the patient falls at home and injures an adjacent spinal level. Dr. Smith, of the same group practice as Dr. Jones, performs the second repair during the global period of the initial surgery. Because the initial repair carries a 90-day global surgical period, you might guess that Medicare will bundle the second herniated disk repair surgery into the surgical package. In fact, Medicare will bundle the second spinal repair into the global period of the first spinal repair unless you append modifier -79 (Unrelated procedure or service by the same physician during the postoperative period) to the second procedure, says Barbara Cobuzzi, MBA, CPC, CPC-H, CHBME, president of Cash Flow Solutions Inc., a Lakewood, N.J., reimbursement consulting firm. As section 15501H of the Medicare Carriers Manual (MCM) explains, "Physicians in the same group practice who are in the same specialty must bill and be paid as though they were a single physician."

If the same surgeon performs both surgeries, you should append modifier -79 to the second procedure. You should follow that same logic, therefore, if two different surgeons in the same practice perform the two surgeries. Also, your carrier will launch a new global period starting on the date that you performed the recurrent hernia repair, says Dianna Hofbeck, RN, CCM, ACFE, president of North Shore Medicine Inc., a national billing service in southern New Jersey. Even though only about 30 days remained on the patient's original global period, the payer will begin a new global period for an additional 90 days, she says. Modifiers Aren't Necessary for Different Specialists If two surgeons in your group practice of different specialties attend to the same patient during a global period, you do not [...]