jshaw8808
Guest
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!
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!