Wiki 77427 RadOnc global period private payors

[caleyc313@gmail.com]

Is anyone trying to bill E/M code during global period and having any luck getting it paid by private payors?

 

[sls314]

Is anyone trying to bill E/M code during global period and having any luck getting it paid by private payors?

My first question is: What is the reason you'd want to bill an E/M code during the global period for 77427?

If there is a new metastatic site that wasn't part of the initial treatment plan, you can bill an E/M to address the new metastasis. There are some specific limited circumstances where you could bill the E/M visit in that 90-day global period.

However, you can't bill an E/M code for a routine post-treatment follow-up in the global period. My providers will occasionally have a patient come back in after 3 weeks - I don't bill those visits. Occasionally a patient will be scheduled too early, for example 85 days after treatment ended - I don't bill those visits either.

 

[caleyc313@gmail.com]

My first question is: What is the reason you'd want to bill an E/M code during the global period for 77427?

If there is a new metastatic site that wasn't part of the initial treatment plan, you can bill an E/M to address the new metastasis. There are some specific limited circumstances where you could bill the E/M visit in that 90-day global period.

However, you can't bill an E/M code for a routine post-treatment follow-up in the global period. My providers will occasionally have a patient come back in after 3 weeks - I don't bill those visits. Occasionally a patient will be scheduled too early, for example 85 days after treatment ended - I don't bill those visits either.

Thank you, these are follow-ups post tx with no new dx. My physicians are wanting to bill as they fill rules of global only apply to Medicare and not private ins.