E/M follow up during 10 day global

Kisselml

Contributor
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Patient is regularly seen for migraines by one provider and receives Botox injections for migraines by separate provider, same office same specialty. It appears a follow up appointment had been scheduled at patient's previous E/M encounter. Between the completed visit and the upcoming visit patient was scheduled for the Botox injection, looks like it was cancelled and rescheduled, twice. The Botox appointment was 4/27 and the pre-scheduled follow up was 5/4. In the follow up note it is documented that there was improvement with the pain from Botox but not at goal and increased oral rx by half current dose. Provider feels they should be able to bill the follow up because it was a follow up for migraine medication and not the Botox injection. If the Botox is part of the treatment is it still not considered related, regardless of the management of oral medication?
 

thomas7331

True Blue
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The global surgical package includes follow-up care for the procedure itself, but per the CMS global surgery guidelines, does not include "treatment for the underlying condition or an added course of treatment which is not part of normal recovery from surgery". So, for example, if a patient had surgery for breast cancer, an encounter involving management of the chemotherapy directed at the cancer would not be considered global. I think the same applies in the situation you describe, and if the documentation supports that the provider is managing the migraine and not the routine post-operative care for the procedure itself, then I believe they would be eligible to bill for the service.
 

jbland

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If you are using the same dx for the follow up visit as you did the botox injection during the global period, insurance will not pay. That has been my experience in the past, migraine can not be mentioned in the notes or dx.
 
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