Wiki Billing post-operative care

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crystalm

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Hi. We have a situation that came up in our office that we are unsure on how to code. We have an orthopedic physican who comes to our facility 5 days per month. He is contracted through our clinic, and we do the coding and billing for anything he does while here. He is not a locum. He also practices in another town near here and does a lot of his surgeries there. The problem we are running into is, can we bill post-operative care when it is done in our facility, when the surgery was performed in another town, but by the same physician? Would we want to append the modifier -55 to this? Any suggestions would be appreciated! :confused:
 
I would think that since the same provider performed the surgery is also doing the follow-up, it would be global regardless of where he sees the patient.

~L
 
Cite Proof?

Can anyone cite any "proof" of how to do this? I have been researching for a smiliar situation, and I can't find anything.
 
Same physician/surgeon, same Tax ID#, regardless of where he sees the patient - it is global.

Authorative Source:
Medicare Global Surgery Fact Sheet
 
Bill for Post Op Care?

If the patient is in a global period for a surgical procedure that the Physician performed, what billable service would the patient be receiving? If the modifier 55 is appended, the surgery billing would need to include a 54, and reimbursement would be reduced.

I am sorry, but perhaps I am not understanding the situation. From your post:
"The problem we are running into is, can we bill post-operative care when it is done in our facility, when the surgery was performed in another town, but by the same physician?"

If the surgeon performs a procedure in a facility that is yours, as an employee of yours, why would/should there be any additional reimbursement due to the clinic? Just wondering.

Karen Gallagher, CPC, COSC
 
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