Radiology Coding Alert

Global periods which define a package of services associated with certain radiology codes often include pre- and postoperative care. But occasionally, radiologists can report E/M services that fall outside of the global surgical package.

During a global surgical period, payment for services typically associated with the surgical procedure is bundled to the surgical code, and the services are not separately reportable.

Because interventional radiology services are generally less invasive than other surgical procedures, they usually carry a global period of 10 days or fewer. Some procedures, such as introduction of percutaneous transhepatic catheter for biliary drainage (47510), carry a 90-day global period. The following three tips can help your practice continue to ethically collect reimbursement for some medically necessary services during the global period.

1. Distinguish Consults From Preoperative Visits If you see a new patient and decide that she is a great candidate for surgery, your visit may not be included in the global surgical package. Suppose a gastroenterologist refers a biliary obstruction patient to your practice and asks you to locate the obstruction source and determine potential ways to correct the obstruction. The interventionalist evaluates the patient and schedules her for surgery.

If you truly performed a consultation, and the three Rs (request for your opinion, review of the patient, and report back to the requesting physician) are documented, you should report 99241-99245 for the office visit, says Barbara Rutigliano MS, RT(R), CPC, coding coordinator at Jefferson X-Ray Group PC, the largest radiology private practice group in Connecticut.

If we see a new or established patient and do a full workup and then decide to do surgery, we charge for the office visit on the date of the consult, and we report the surgery on the surgical date, Rutigliano says.
You Must Perform Full E/M Visit Remember that your E/M visit must be medically necessary and separately identifiable from the surgery, and that you must fulfill all of the "bullets" that CMS identifies in its E/M documentation guidelines before you report the E/M code. Simply seeing the patient to decide whether he or she requires surgery is usually not enough to warrant reporting an E/M code. The National Correct Coding Initiative (NCCI) guidelines state, "When physician interaction is necessary to accomplish a radiographic procedure, typically occurring in invasive or interventional radiology, the interaction generally involves limited pertinent historical inquiry about reasons for the examination, the presence of allergies, acquisition of informed consent, discussion of follow-up, and the review of the medical record. In this setting, a separate evaluation and management service is not billed." The NCCI Edits also states that if the [...]