Question Cardiologists Ever Perform Aftercare for Cardiac Surgery?

jshaw8808

Contributor
Messages
11
Best answers
0
This relates to an academic case and don't want to be too specific so as to give the answer away...

I have a case of a new patient to a cardiologist, a Medicare patient, who was there for a "hospital followup" to a CABG procedure, a month and a half afterwards, so, within the Global Period. The patient had been to their primary physician a week prior, due to some lower extremity issues likely related to the procedure, and been given an antibiotic. The cardiologist examined the patient and diagnosed him with venous insufficiency.

Since the patient was within the GP, and based on some online research, I decided that the proper way to deal with this to report the original CABG procedure code with modifier 55. It is my understanding that in so doing, one would need to submit additional information as to how much of the post-operative care will be provided by this cardiologist.

However, another coding authority told me that "a cardiologist does not provide follow up visits for any procedure performed by the cardiothoracic surgeon. A cardiologist is a medical doctor and [a] cardiothoracic is [a] surgeon." This authority said this visit should be coded simply as a new patient office visit.

Yet, I found the following example from physiciannews.com, albeit second-hand from these forums:
<excerpted>
"Modifier -55 is used when one physician does the surgery and another physician provides post-operative care. To bill for post-operative care without performance of the surgery, attach a modifier -55 to the procedure code. Post-operative care begins the day after the surgery. If it becomes necessary for the surgeon to address a problem during the post-operative period, it can be billed separately if the service contains a diagnosis which is separate from the original procedure... For example, when a patient undergoes a cardiac procedure performed by a cardiothoracic surgeon and then the follow-up care is rendered by the patient's cardiologist, Modifier -55 would be added to the codes submitted by the patient's cardiologist. Modifier -55 can have an effect on payment of the service and may be used on Medicare claims."

So, I guess I have two questions:
1. Is it really true that cardiologists never handle followup visits for cardiac surgery?
2. Does the fact that there was a new condition diagnosed - venous insufficiency - mean that we can skip the hassle of modifier 55 and simply code a new patient office visit? (I'm not sure what is meant by "a diagnosis which is separate from the original procedure" - does that mean different at all, or does it mean unrelated?)

Thanks!
 

Partha45

Networker
Messages
53
Location
Chennai Local Chapter
Best answers
0
Physicians Who Furnish Part of a Global Surgical Package

Where physicians agree on the transfer of care during the global period, the following modifiers are used:

• “-54” for surgical care only; or
• “-55” for postoperative management only.

Both the bill for the surgical care only and the bill for the postoperative care only, will contain the same date of service and the same surgical procedure code, with the services distinguished by the use of the appropriate modifier.

Providers need not specify on the claim that care has been transferred. However, the date on which care was relinquished or assumed, as applicable, must be shown on the claim. This should be indicated in the remarks field/free text segment on the claim form/format. Both the surgeon and the physician providing the postoperative care must keep a copy of the written transfer agreement in the beneficiary’s medical record.

Where a transfer of postoperative care occurs, the receiving physician cannot bill for any part of the global services until he/she has provided at least one service. Once the physician has seen the patient, that physician may b

EXCEPTIONS:

• Where a transfer of care does not occur, occasional post-discharge services of a physician other than the surgeon are reported by the appropriate evaluation and management code. No modifiers are necessary on the claim.

• If the transfer of care occurs immediately after surgery, the physician other than the surgeon who provides the in-hospital postoperative care bills using subsequent hospital care codes for the inpatient hospital care and the surgical code with the “- 55” modifier for the post-discharge care. The surgeon bills the surgery code with the “-54” modifier.

• Physicians who provide follow-up services for minor procedures performed in emergency departments bill the appropriate level of office visit code. The physician who performs the emergency room service bills for the surgical procedure without a modifier.

If the services of a physician other than the surgeon are required during a postoperative period for an underlying condition or medical complication, the other physician reports the appropriate evaluation and management code. No modifiers are necessary on the claim. An example is a cardiologist who manages underlying cardiovascular conditions of a patient.


Page#93 & 94
 

thomas7331

True Blue
Messages
2,290
Best answers
5
Agree with the above. Cardiology is a different specialty from cardiovascular surgery. You do not need to consider a global period or bill a global period modifier in this situation since services of providers of different specialties are always excluded from the global package. The only case where you would submit the modifier 55, as described above, is if there was an explicit agreement to transfer the patient to the cardiologist specifically for the post-operative care - it would also be necessary to coordinate this with the surgeon to ensure that they are billing the 54 modifier as well as the same surgical code and date of service.

If the cardiologist is not taking over the postoperative care, there is no need to consider the global period. Personally, having worked with cardiologists for many years, I have never seen a cardiologist take over post-operative care - surgical follow-up (which usually consists primarily of overseeing wound care and rehab/recovery services) is not a normal part of their specialty and most of them are far to busy to do this. You see this occasionally with optical professions where an optometrist with take the follow up care for cataract surgeries, but it is rare in other surgical areas to see a transfer of care outside of the practice or specialty.
 
Top