Wiki Conditions within the global period

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GSCoder07

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Could any one please tell me where I can find a listing or something that says exactly what is included or not included in the global period while the patient is in the hospital? My physicians are always trying to bill E/M's when the patient is in the global period. I know complications are not separately reportable but I need some other documentation that shows what could be reported.
Any help would be greatly appreciated.
Happy Thanksgiving!! :)
 
LLott said:
Could any one please tell me where I can find a listing or something that says exactly what is included or not included in the global period while the patient is in the hospital? My physicians are always trying to bill E/M's when the patient is in the global period. I know complications are not separately reportable but I need some other documentation that shows what could be reported.
Any help would be greatly appreciated.
Happy Thanksgiving!! :)
Click to expand...


Here is CMS's fact sheet on Global Periods; it has lists of services that are both included and not included.


http://www.cms.gov/Outreach-and-Edu...oducts/downloads/GloballSurgery-ICN907166.pdf


This differs slightly from the AMA's Global Period Guidelines in the CPT book, which does allow complications related to the surgery to be billed seperately, whereas Medicare only allows for complications if they result in a return to the OR. Check with your payers to see which guidelines they follow.

Hope this helps! :)
 
Meagan and Karen, I appreciate you taking the time to help me. I found those materials helpful.
I am having an issue with the physician trying to bill E/M's in the global period. The patient is self pay. Here's what happened, the patient had a perferated gastric ulcer repaired. The physician is trying to bill each day after the surgery. He states he went beyond "outside of the surgical global concept". The patient has diabetes so he was trying to help manage that. Does that justify billing an E/M in the post-op period? I don't find where he went beyond the global besides that. The patient did have a rebleed of the ulcer. He did not go back to surgery but was just monitored.
I am stuck on billing these out or changing them to post-op visits. I don't want to do the wrong thing here. Any help, thoughts, ideas, would be greatly appreciated. :)
 
LLott said:
Meagan and Karen, I appreciate you taking the time to help me. I found those materials helpful.
I am having an issue with the physician trying to bill E/M's in the global period. The patient is self pay. Here's what happened, the patient had a perferated gastric ulcer repaired. The physician is trying to bill each day after the surgery. He states he went beyond "outside of the surgical global concept". The patient has diabetes so he was trying to help manage that. Does that justify billing an E/M in the post-op period? I don't find where he went beyond the global besides that. The patient did have a rebleed of the ulcer. He did not go back to surgery but was just monitored.
I am stuck on billing these out or changing them to post-op visits. I don't want to do the wrong thing here. Any help, thoughts, ideas, would be greatly appreciated. :)
Click to expand...

I'll gladly give my opinion on this situation...

Since the surgeon was managing more than just the post-op wound care, he just might be justified in billing the follow-ups on those days after surgery, as long as his documentation supports it. But was the patient's PCP, or maybe a hospitalist, also managing the diabetes? If yes, then it might be hard for your surgeon to support following the same condition, which only leaves him the "rebleed complication"...and since there's no insurance company involved to check the records, I'd say use your judgement based on how detailed his documentation is. The AMA guidelines do allow billiing in the global period for complications, so as long as he documents well, I'd say it should be OK to code it.

Hope this helps some! :confused:
 
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