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Wiki Dressing Change
- Thread starter R1CPC
- Start date
jdibble
True Blue
You would not bill a procedure code for the dressing change unless it is done under anesthesia. You could bill an E/M for the dressing change unless it is during the global period of a surgical procedure - then it would not be billable. The Biopatch could be billed with HCPCS code A6209, but it would depend on the carrier if it would be reimbursed.
mitchellde
True Blue
No , your office nurse cannot follow up on a different physician procedure/ service. Also to perfom a service that is part of a different physician global, the surgeon must transfer the care to the new physician and the new provider bills the surgical procedure with modifier 55. If there is no global, then your provider must see the patient and have a plan of care that the nurse can follow for future visits to be able to bill the 99211.
CatchTheWind
Guest
I disagree. A provider can do a dressing change (or wound follow-up, suture removal, etc.) from a procedure done by another physician. This would usually be billed as 99211. The global surgery rules only apply to physicians in the same practice. (CMS's "Global Surgery Fact Sheet" specifically says "Medicare payment for the surgical procedure includes the preoperative, intra-operative, and post-operative services routinely performed by the surgeon or by members of the same group with the same specialty.")
mitchellde
True Blue
The provider can but the office nurse in a different office cannot. A different provider can provide post operative services, however the surgeon must transfer care to that provider and it is billed using the surgical code with the 55 modifier. The surgical global applies to the surgery. If a different physician outside the practice bills for post op care without using the 55 modifier it will not be paid. You must use the V codes for post op as the diagnosis as well. This is what the 55 modifier is created for and is covered in the Medicare manual.
So again if the patient had surgery in a different office and presents for follow up to your office, your office nurse cannot be the one providing the service. Your provider may provide the service as long as it is billed using the surgical code with the 55 modifier.
mitchellde
True Blue
Here is the section on post op global
3. 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 bill for the period beginning with the date on which he/she assumes care of the patient.
3. 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 bill for the period beginning with the date on which he/she assumes care of the patient.
CatchTheWind
Guest
I realize that I was mistaken one aspect of this, and apologize to anyone I misled. A provider, not a nurse or MA, has to see the patient in order to bill for a dressing change or suture removal following surgery performed by another practice. This is not due to global surgery rules, but to "incident to" rules, which require (among other restrictions) that a provider in your own practice has assessed the problem and determined the plan of care.
Regarding the global period, CMS is explicit that except in those cases in which two doctors have chosen to arrange a transfer of care, another practice is permitted bill as usual. CMS's Global Surgery Fact Sheet states: "Services of other physicians related to the surgery.... are not included in the global surgery payment... except where the surgeon and the other physician(s) agree on the transfer of care.... Where a transfer of care does not occur, the services of another physician may... be paid separately.... In the same Fact Sheet, they also state: "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.... Physicians who provide follow-up services for minor procedures performed in emergency departments bill the appropriate level of E/M code, without a modifier."
I also found an article by Inga Ellzey addressing this: "(Q): What if the patient just comes in for suture removal when the surgery was performed by another practice? Can I bill if the follow-up visit is billed during the postoperative period? How do I bill? Do I use modifiers 54 or 55? (A): Absolutely, you should bill for the services you provide. In most instances, you will not even know what CPT code was billed by the surgeon, how many postoperative days the procedure has, or how many postoperative days remain. Since you are in a different practice, you are not subject to the follow-up or global period of the other provider (eg, performing surgeon). Important: Do not use any modifiers such as 54 or 55 as they are not appropriate for the scenarios discussed above."
Regarding the global period, CMS is explicit that except in those cases in which two doctors have chosen to arrange a transfer of care, another practice is permitted bill as usual. CMS's Global Surgery Fact Sheet states: "Services of other physicians related to the surgery.... are not included in the global surgery payment... except where the surgeon and the other physician(s) agree on the transfer of care.... Where a transfer of care does not occur, the services of another physician may... be paid separately.... In the same Fact Sheet, they also state: "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.... Physicians who provide follow-up services for minor procedures performed in emergency departments bill the appropriate level of E/M code, without a modifier."
I also found an article by Inga Ellzey addressing this: "(Q): What if the patient just comes in for suture removal when the surgery was performed by another practice? Can I bill if the follow-up visit is billed during the postoperative period? How do I bill? Do I use modifiers 54 or 55? (A): Absolutely, you should bill for the services you provide. In most instances, you will not even know what CPT code was billed by the surgeon, how many postoperative days the procedure has, or how many postoperative days remain. Since you are in a different practice, you are not subject to the follow-up or global period of the other provider (eg, performing surgeon). Important: Do not use any modifiers such as 54 or 55 as they are not appropriate for the scenarios discussed above."
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veldarivard
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Dressing Change/similar question
This question is similar to this thread:
Scenario: Patient had a debridement and the MD wants him to come in MWF for a dressing change. The patient comes in and the medical assistant does a procedure note for dressing change. I thought it should be charged a 99211; however, I was told that there needs to be an actual signed order from the MD in the medical record to be able to charge. I did a lot of research and it sounds like if the MD is on the premises and if there is no global we should be able to charge a 99211 for the medical assistant's procedure (dressing change). So my main question is does there have to be an order?
This question is similar to this thread:
Scenario: Patient had a debridement and the MD wants him to come in MWF for a dressing change. The patient comes in and the medical assistant does a procedure note for dressing change. I thought it should be charged a 99211; however, I was told that there needs to be an actual signed order from the MD in the medical record to be able to charge. I did a lot of research and it sounds like if the MD is on the premises and if there is no global we should be able to charge a 99211 for the medical assistant's procedure (dressing change). So my main question is does there have to be an order?
CatchTheWind
Guest
There has to be a diagnosis and plan (or order) documented from a doctor in your practice. This is required under "incident to" rules, since the care is provided by a nurse or MA and billed under a provider.