90 days global period but patient has no insurance

[Annabel]

My provider did an Excision or destruction, open, intra-abdominal tumors, cysts or endometriomas, 1 or more peritoneal, mesenteric, or retroperitoneal primary or secondary tumors; largest tumor 5 cm diameter or less (49203) on a self pay patient which the patient has been billed for already. He is now performing a wound vac change three times a week. The wound vac change is normally done by the Home Health Services but since this patient has no insurance, my provider is taking care of the wound vac change as well. The question is that since this procedure 49203 has a 90 days global period and my provider would normally just do a post op visit and not necessarily a wound vac change, should we be billing the patient for the wound vac change?

I told my provider that I don't think we can because the 90 days global period applies to everyone regardless if the patient has insurance or not. So if a patient with insurance has a 90 days global period "benefit" then a patient with no insurance should have the same benefit as well. He disagrees because he says that on a patient with insurance he doesn't take care of the wound vac change and now with this patient that has no insurance he is taking care of the wound vac change.

Hope I didn't confuse anyone..... Please clarify this for us...

Thanks!
Annabel - CPC