Orthopedic Coding Alert

When different orthopedists in your practice treat a patient during her global surgical period, Medicare often includes their treatment in the global package, even if they did not personally perform the surgery. But this doesn't mean that you should write off all of your practice's treatments, particularly if other specialists within your practice see the patient for a separate procedure.
 
Because all orthopedic surgeons in the practice share the same tax identification number, Medicare considers them the "same" physician, but this doesn't hold true for specialists such as podiatrists, physiatrists, internists, etc. Use Modifiers to Separate Surgeries Consider this scenario, submitted by Patti Cox, coder at South Bend Orthopaedics, a 14-physician practice in South Bend, Ind.: Dr. Smith performs an open reduction, internal fixation (ORIF) of a patient's bimalleolar ankle fracture (27814, Open treatment of bimalleolar ankle fracture, with or without internal or external fixation).
 
Forty days later, Dr. Jones, an orthopedic surgeon with Dr. Smith's practice, performs an arthroscopic rotator cuff repair (29827, Arthroscopy, shoulder, surgical; with rotator cuff repair). Because the ORIF carries a 90-day global surgical period, will Medicare bundle the rotator cuff surgery into the surgical package?
 
Yes, unless you append modifier -79 (Unrelated procedure or service by the same physician during the postoperative period) to 29827, says Barbara Cobuzzi, MBA, CPC, CPC-H, CHBME, president of Cash Flow Solutions Inc., a Lakewood, N.J., reimbursement consulting firm. Otherwise, she says, the carrier will consider it bundled into the ankle surgery's global period.
 
This is because section 15501H of the Medicare Carriers Manual (MCM) states, "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 orthopedists in the same practice perform the two dif-ferent surgeries.
 
You should note that your carrier will launch a new global period starting on the date that you performed the rotator cuff repair. Even though only 50 days remained on the patient's original global period, she will be under the new global period for an additional 90 days. Different Specialist, Different Story In another scenario, let's say a podiatrist in your practice performs a bunionectomy (28290, Correction, hallux valgus [bunion], with or without sesamoidectomy; simple exostectomy [e.g., Silver type procedure]). During his 90-day global period, the patient dislocates his elbow, requiring open repair (24615, Open treatment of acute or chronic elbow dislocation) by an orthopedic surgeon at the same practice.
 
This time, Medicare will not view both physicians as the "same" surgeon, because they practice under different specialties. The MCM states, "Physicians in the same group practice but [...]