Billing for Post-op Follow-up Days

boogie9483

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Good Afternoon,

I am looking for the billing guidelines for “Post-op Follow-up Days”. I cannot find anything to support the passage below:

Link:
http://www.health.ny.gov/health_care/medicaid/program/update/2012/2012-02.htm#billing

Billing for Post-op Follow-up Days
The following information clarifies Medicaid's fee-for-service policy on billing for post-op follow-up days.
Patients often return to the hospital clinic for aftercare appointments following a surgical procedure that took place in one of the following settings:
• Inpatient hospital;
• Hospital ambulatory surgery unit; or
• Hospital clinic.
Facilities may bill Medicaid for these visits. This policy applies to post-op aftercare visits that are billed under Ambulatory Patient Groups (APGs), as well as to those aftercare visits that took place prior to the implementation of APGs.
NOTE: The physician may not bill for aftercare visits. Payment to the physician for surgical procedures includes the surgery and the follow-up care. The number of follow-up days assigned to each surgical procedure can be found in the "Physician Manual - Surgery Services Fee Schedule." This information can be accessed at the following website:
https://www.emedny.org/ProviderManuals/Physician/index.aspx.
Medicaid Managed Care
Medicaid managed care and Family Health Plus (FHPlus) plans will reimburse in-network providers according to established provider agreements. Reimbursement for out-of-network providers will be at negotiated rates. Questions concerning managed care reimbursement rates should be directed to the health plan Provider Services number.
Questions regarding Medicaid fee-for-service policy and claiming should be sent via e-mail to: pffs@health.state.ny.us.


99024 does not seem appropriate due to the status indicator of B- Codes that are not recognized by OPPS when submitted on an outpatient hospital Part B bill type (12x and 13x). Not paid under OPPS. May be paid by fiscal intermediaries/MACs when submitted on a different bill type, for example, 75x (CORF), but not paid under OPPS; An alternate code that is recognized by OPPS when submitted on an outpatient hospital Part B bill type (12x and 13x) may be available.

How do we bill for this? Where can i find the guidelines?

Thanks!!!!
 

boogie9483

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This is what I was able to find:
https://www.gpo.gov/fdsys/pkg/FR-2000-04-07/pdf/FR-2000-04-07.pdf
Pg#236
The packaging that we proposed as the basis for determining APC payment rates and that we will implement under the hospital outpatient PPS is generally consistent with MedPAC’s recommendation. However, we did not propose to include ‘‘limited follow-up services’’ in our packaged groups under the hospital outpatient PPS because of the difficulty of matching in our database the costs of these services with their associated primary encounter. For now, hospitals are to bill follow-up care, such as suture removal, using an appropriate medical visit code. We did not propose, nor have we included in this final rule with comment period, provision for a global period for hospital outpatient services analogous to the global period affecting payments for professional services made under the Medicare physician fee schedule.

Another article that supports this is:
http://www.hcpro.com/HIM-247517-859/QA-Billing-for-technical-component-of-clinic-visit.html

The OPPS payment system does not include a global period (i.e. a period of time after a procedure during which care related to the procedure is included in the original procedure performed).

This is a feature of the physician payment system, and appropriate relative values are set to include this care. However, this additional care is not a part of the OPPS rate-setting methodology. Therefore, if a hospital schedules visits following a procedure, those visits are separate from the original procedure, regardless of how the professional portion of the visit is paid (i.e. as part of the global period for the physician in this case). Hospitals should bill for those visits as they would for any other patient visit. Bill the appropriate CPT code for procedures denoted by CPT codes. If no CPT code describes services rendered, assign the appropriate E/M visit code. Follow your hospital visit guidelines to determine which E/M level you should bill for the technical component.



Just an fyi for people that may be asking the same question.
 

thomas7331

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If your Medicaid payer reimburses facility charges under OPPS, as would seem to be the case based on the information you've posted, then the 'alternate code' they're probably looking for here is G0463 for all physician E&M services.
 
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