19357 after 90 day global is over?!

aireon

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My plastic surgeon billed a 19357 in August 2010. He is continuing to see the patient and billing 99024(post op) and she is well out of her 90 day global period. He is saying based on the code including the phrase"including subsequent expansion", he can continue to see her and not bill even thought the global period is up because he can't bill for the expansion alone, and that is the only reason she is coming in. I think if a global period is assigned, the expansion is included, but still within the global period only. Otherwise 19357 should not have a global on it,right?


Any help?
:confused:
 

skildare

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If she is coming in for just a tissue expander filler, he is correct that this cannot be billed. Even if it is out of the 90 day global expansions are included in the original surgery. There would have to be something above and beyond the filler to charge for a visit.
 

gailmc

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I agree with Shannon, the tissue expander filler is included in the primary procedure even if it is outside the 90 days global period.
 

Rhoock

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If a patient has to stop expansion for radiation treatment and 6 to 8 months go by can the doctor charge for subsequent expansions, if so is there a modifier and would you use 11954?
 

ABonnell CPC

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You wouldnt bill 11954. In the April 2014 edition of the AAPC mag, this issue is addressed on page 30. Talk to your physician, find out if during the fill if the physician is completing a problem focused history & exam w/straightforward medical decision making. The visit/fill would then be billed as 99212.
 
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