Billing after kidney transplants

MelodyJ

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1. After a kidney transplant, can the urologist bill for immunosuppression during the global period since technically this is what the patient is now being treated for versus renal failure?

2. If the patient rejects the kidney during the global period, can the urologist bill for the services (E/M, procedures etc.) or is this considered a complication of surgery?

Thank you for any help I can recieve. I am new to this area.
 
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Milwaukee WI
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Medicare

Scenario # 1 is global no matter how you try to phrase it. It is directly related to the surgery performed and is therefore postoperative care.

Scenario # 2 ... Medicare will not pay for any services in the postoperative period unless they require a trip to the OR. Complications are considered part of postoperative global package per Medicare.

Commercial insurance MIGHT consider you scenario # 2 as a legitimate separately reportable E/M service. (But I'm guessing all your transplant patients were on dialysis and therefore covered by Medicare.)

Hope that helps.

F Tessa Bartels, CPC, CEMC
 

MelodyJ

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Thank you Tessa for the input. Would you mind if I contacted you for further questions? My email is mjames@ssook.org if you would like to email me your information.

Melody James, LPN
Compliance Auditor
Surgical Specialist of Oklahoma, pllc
 
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Could I get clarification? I have a kidney transplant AND kidney failure. Documentation does not clarify which kidney was transplanted and which one is in failure. Can I still use the T84.12, or do I need to know that it was the actual transplanted kidney that is in failure? thank you!
 

ASH527

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Scenario 1. You can bill for the immunosuppressant visits. The documentation/visit note has to be specific to the immunosuppressant per the Medicare guidelines for transplant visits in the global period. Use the mod 24 and diagnosis Z51.81 and Z48.22 and Z94.0. I have gotten paid.
Scenario 2. Only if the patient had a return to the operative suite, would a surgery be paid and you would need to use a modifier. No office visits, these are considered global
 
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