Revenue Cycle Insider

Question: What should we bill for a post-op visit on a surgery performed elsewhere?

Normally, I know 99024, but in this case the surgeon would be doing the initial visits in our Federally Qualified Health Center (FQHC) clinic, surgery through a hospital unrelated to our facility, and post-op visits in our FQHC clinic. The same provider is performing the services through two different practices on our patients. As an unrelated medical facility, I wouldn't think we would be considered part of the surgical package, but it is the same doctor.

AAPC Forum Subscriber

Answer: The surgeon’s payment for the post-op visit is included in the surgery payment. According to the Medicare Claims Processing Manual, Section 40, surgical procedures include payment for pre-op visits, intra-operative, and post-op visits — as well as postsurgical pain management, supplies, and miscellaneous services specific to the performed procedure. Payment for the aforementioned services is made to the physician who performs the surgery.

The manual states, “Physicians who perform the surgery and furnish all of the usual pre- and postoperative work bill for the global package by entering the appropriate CPT^® code for the surgical procedure only.” Medicare also indicates that the global surgical package can be performed in any setting, including hospitals, physicians’ offices, and ambulatory surgical centers (ASCs).

Code 99024 (Postoperative follow-up visit, normally included in the surgical package, to indicate that an evaluation and management service was performed during a postoperative period for a reason(s) related to the original procedure) is a good tracking code. The code has does not have a dollar value tied to it according to the Medicare Physician Fee Schedule, meaning the physician won’t receive reimbursement for reporting the code. However, it allows you to keep track that the patient presented for the follow-up visit within the surgical period.

Mike Shaughnessy, BA, CPC, Development Editor, AAPC