Wiki Anthem Global Period

[hjenni4024]

I have been billing post-op visits to Anthem with the first diagnosis V67.00 and then same diagnoses as the surgery, but Anthem does not process as part of global period. I know other payers will automatically adjust off as global once the surgery has been processed. Does Anthem want post op visits billed a certain way?

 

[OCD_coder]

You should not be billing for routine postoperative visits for any carrier. They are part of the surgery during the global period.

Medicare and carriers that follow Medicare global rules do not allow ANY postop visits to be billed whether it is routine or a complication from surgery.

 

[hjenni4024]

Normally we don't, we have a POV code we use that doesn't get billed to insurance or patient. However I have noticed that in the chance that an office visit does get billed in error, medicare will automatically adjust off as being global but anthem does not. I wondered since we use the V67.00 diagnosis, wouldn't anthem then know that it was a post op visit?

Another thing I wondered was this scenario:

Patient is in post-op period for ankle replacement. Comes in for a POV and dr. does x-rays to check on the recovery progress. Billed it out like this:

DX V67.00, 715.97, 729.5, 782.3

Procedure:
1) POV - does not get billed out
2) 73630 - RT
3) 73630 - LT

Anthem will still put the patient's copay amount to one of the x-rays, so even though we aren't charging an office visit or copay for that date, they are still left with their $20, 30 or 40 copay after it is said and done. Pt. is then upset that they are paying their copay during a global period. Am I billing this incorrectly?

 

[Melissa Harris CPC]

Are you billing an E/M Code?? If it is a follow up visit within the post-op period you should bill a 99024 which does not go out to the insurance carrier but leaves a record of the visit. This way insurances will not make payment. the only time you should bill an E/M Code is if the visit is not related to the surgery.

Melissa Harris, CPC

 

[OCD_coder]

X-ray's are not part of the global package and are billable to all carriers. The patient is still going to have some financial responsibility for these, it is up to the patient to understand their contracts and coverage as everyone is different.

 

[mitchellde]

You should never use the pre operative diagnosis once the surgery is over. A post op follow up is a V code for either follow up or aftercare whichever fits, but do not use the preoperative code even as a secondary code. I agree you should not be billing an office visit code but yes you can bill the x-rays but only with the V code.

 

[hjenni4024]

V67.00 is a post op follow up visit.

Like I said, we normally don't bill out an office visit but sometimes one goes out in error, in which case I notify Anthem and have them recoup.