Otolaryngology Coding Alert

Question: When our physicians see a patient in the hospital following surgery, we have difficulty getting reimbursed for the daily visits because carriers include the visits in the global period. Do you have any suggestions? Arizona Subscriber

Answer: The National Physician Fee Schedule Relative Value File includes follow-up care in the surgical global period. Depending on the type of procedure, the fee includes reimbursement for related services provided during one preoperative day, and zero, 10 or 90 postoperative days. Therefore, you cannot report hospital visits that are related to the surgery during this time.

But you can bill for every day that you provide care after the global period ends. For instance, an otolaryn-gologist performs a partial ethmoidectomy on an asthmatic patient who remains in the hospital for two days to monitor his asthma. On day two, the otolaryn-gologist checks the patient for bleeding and cleans his nose out. For the partial ethmoidectomy on day one, you should report 31254 (Nasal/sinus endoscopy, surgical; with ethmoidectomy, partial [anterior]). Because 31254 has zero postoperative days, you should assign the appropriate-level subsequent hospital care code (99231-99233) on day two, based on the documentation provided. If the operation has a 10-day global surgical period, you may report follow-up care starting on the 11th day. Similarly, if the surgery has a 90-day global period, you should bill for related care starting on the 91st day.

For example, a patient who has radical neck dissection (31365, Laryngectomy; total, with radical neck dissection) goes into respiratory distress on day 91, and the otolaryngologist admits the patient to the hospital. Because 31365 has a 90-day global period and the doctor provides care after the global period expires, you should report the appropriate hospital care code, such as 99231-99233 (Subsequent hospital care, per day), for each day the patient remains in the hospital. When the otolaryngologist discharges the patient, report hospital discharge day management (99238-99239). If the visit is unrelated to the surgery, you may report the appropriate hospital care code, such as 99231-99233, appended with modifier -24 (Unrelated evaluation and management service by the same physician during a postoperative period). Document the visit under a different heading or note than postsurgical evaluations. A separate diagnosis, although not required, will help substantiate that the physician is evaluating the patient for an unrelated condition. Clinical and coding information for You Be the Coder and Reader Questions provided by Barbara Cobuzzi, MBA, CPC, CPC-H, an otolaryngology coding and reimbursement specialist and president of Cash Flow Solutions, a medical billing firm in Lakewood, N.J.; Charles F. Koopmann, MD, MHSA, professor and associate chair of the department of otolaryngology, physician billing director, a member of the faculty group practice at the University of [...]