coding global surgeries

lminneti

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if a pt has surgery not at your surgery center. then comes to your clinic for a follow up from the surgery. how would the follow up be coded? I'm thinking it would be coded with the office visit E&M code. since the surgery was not done at our center by our providers then the global would not cover this follow up. Am I correct?

thanks for the help
 

thomas7331

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If this is just an isolated instance, you can bill the E/M service you provide - CMS guidelines state that "where a transfer of care does not occur, occasional post-discharge services of a physician other than the surgeon are reported by the appropriate E/M code. No modifiers are necessary on the claim."

However, if your physician is routinely doing the post-operative care for a surgery done by another provider of the same specialty, the correct way to bill in this situation is for the original surgeon to submit the surgical code with modifier 54 for 'surgical care only'. Then your provider should submit the same CPT code with modifier 55 for 'post-operative management only'. The payer will then divide the global fee between the two providers according to their guidelines.

Here's a reference that describes this in more detail, see the section ''Physicians Who Furnish Part of a Global Surgical Package" starting on page 4:

https://www.cms.gov/Outreach-and-Ed...oducts/Downloads/GloballSurgery-ICN907166.pdf
 
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