Billing for office visits while in global?

l1ttle_0ne

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We have a urologist questioning if a patient is in a global period, if he can bill for the follow for office visits because the cancer diagnosis. For surgeries billed with a cancer code, and the office visits to be billed with the same diagnosis. It is my impression that you can not bill seperetly for this. Any advice would be great!
 

btadlock1

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We have a urologist questioning if a patient is in a global period, if he can bill for the follow for office visits because the cancer diagnosis. For surgeries billed with a cancer code, and the office visits to be billed with the same diagnosis. It is my impression that you can not bill seperetly for this. Any advice would be great!
The global period applies to services relating to the surgery, not the diagnosis. It's an important distinction to make - the doctor can technically treat the patient for a problem with the same diagnosis code as the one that prompted the surgery, but that doesn't necessarily mean that the new problem is related to the surgery.

Any routine post-operative care relating to the surgery is included in the surgical package, but evaluating and treating for complications (including a recurrance of the original problem) is not, and those visits can be reported separately.

What you should look at, is whether this is a new problem, a complication of surgery, or side effects of treatment. Your doctor may be trying to use the wrong diagnosis code to describe the circumstance (see: ICD-9 guidelines for using aftercare codes). Hope that helps! ;)
 

l1ttle_0ne

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Here is the specific problem were having. We have a patient who had an orchiectomy done and is in his 90 global period, the doctor is seeing him for an office visit to inform him that pathology came back as cancer. Can he bill for the office visit even though the patient is in a global period? Thank you for your help!
 

eadun2000

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Here is the specific problem were having. We have a patient who had an orchiectomy done and is in his 90 global period, the doctor is seeing him for an office visit to inform him that pathology came back as cancer. Can he bill for the office visit even though the patient is in a global period? Thank you for your help!
No he cannot bill for that. Discussion of path is included in the surgery.
 

btadlock1

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No he cannot bill for that. Discussion of path is included in the surgery.
Taking a sample for path is included in the biopsy/surgery - discussing the results isn't. The cancer is technically a "new" problem, since it's never been diagnosed before. The provider would have to determine a plan of treatment , and educate the patient on their condition, which constitutes MDM. This would be coded with the cancer diagnosis, not the signs/symptoms that led to the biopsy.
 

m.j.kummer

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Taking a sample for path is included in the biopsy/surgery - discussing the results isn't. The cancer is technically a "new" problem, since it's never been diagnosed before. The provider would have to determine a plan of treatment , and educate the patient on their condition, which constitutes MDM. This would be coded with the cancer diagnosis, not the signs/symptoms that led to the biopsy.
I could not have said it better nor with fewer words!
 
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