Wiki Charging in a Global Period

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Linda77

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Hello Everyone I was hoping you guys could help me out. I have a doctor that is wanting to charge for rounding on a patient he has in house even though the patient is post op during this stay. And he was the surgeon.
He states he is wearing 2 hats one as his surgeon and one as his primary. He stated the global doesn't apply when he is rounding for his DM that is uncontrolled and can charge. I told
him I didn't think it worked that way. Yes, his DM is uncontrolled and had complications that is why he did an amputation. Does anyone know of a modifier for these kinds of scenario or does it fall under the 90 day global? Need something to go back to the Doctor with. Thanks!!
 
Linda77 said:
Hello Everyone I was hoping you guys could help me out. I have a doctor that is wanting to charge for rounding on a patient he has in house even though the patient is post op during this stay. And he was the surgeon.
He states he is wearing 2 hats one as his surgeon and one as his primary. He stated the global doesn't apply when he is rounding for his DM that is uncontrolled and can charge. I told
him I didn't think it worked that way. Yes, his DM is uncontrolled and had complications that is why he did an amputation. Does anyone know of a modifier for these kinds of scenario or does it fall under the 90 day global? Need something to go back to the Doctor with. Thanks!!
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If the services being rendered are unrelated to the procedure, then the visit can be billed with modifier 24.
 
vanessamoldovan said:
If the services being rendered are unrelated to the procedure, then the visit can be billed with modifier 24.
Click to expand...
Hello Thank you for your reply! So does the Doctor need to document that the visit is for the DM and not the amputation ? Because currently he addresses the wound site in addition to the DM.
 
It's fine if there is 1 note (while he is wearing 2 hats), addressing both the DM & the postop care. When you level the visit though, don't count anything that was the postop care, so it may wind up at a low level.
To determine what is or is not included in global, the CMS booklet is very helpful (page 6 & 7) for Medicare or any carrier following Medicare guidelines.
https://www.cms.gov/Outreach-and-Ed...oducts/Downloads/GloballSurgery-ICN907166.pdf
I will note in my area, it would be unusual for the surgeon to manage the DM care. Typically, a hospitalist will manage co-morbidities.
 
csperoni said:
It's fine if there is 1 note (while he is wearing 2 hats), addressing both the DM & the postop care. When you level the visit though, don't count anything that was the postop care, so it may wind up at a low level.
To determine what is or is not included in global, the CMS booklet is very helpful (page 6 & 7) for Medicare or any carrier following Medicare guidelines.
https://www.cms.gov/Outreach-and-Ed...oducts/Downloads/GloballSurgery-ICN907166.pdf
I will note in my area, it would be unusual for the surgeon to manage the DM care. Typically, a hospitalist will manage co-morbidities.
Click to expand...
Thanks a bunch !!
 
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