E&M Visit during post op for path results

thensel

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Can an E&M visit be billed during the post op period when the provider reviews the path results with the patient for a lesion that was excised and sent to pathology or is this included in the global payment for the surgical procedure? I can't find where this scenario is documented on line in the NCCI narrative or CMS website. Thanks for your help.
 
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Global Surgical Period

If you are reviewing the path report from the original surgery and it is within the global surgical period the visit is not separately payable.
 

OCD_coder

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It can depend on the documentation a little bit and carrier (if they follow strictly by MCR global rules).
Did the course of treatment change from the surgical procedure? If yes - you can bill a separate E/M with a modifier 24 added. This type of situation happens a lot with oncology physicians that remove a tumor then a new treatment plan is initiated postop as they did not know what kind of cancer the patient had until the surgery.
But if just the findings are given and no change has occured to the treatment plan, then No a separate E/M would not be billable as the patient would be recovering normally from the procedure.

Per CPT:
“Followup care for diagnostic procedures includes only that care related to
recovery from the diagnostic procedure itself. Care of the condition
for which the diagnostic procedure was performed or of other co-existing
conditions is not included
.�

MCR (from the March 2011 Coding Edge)
Medicare's definition of the global package is broader than the
AMA's, but clearly states, “Services not included in the global surgical
package are as follows:
• The initial consultation or evaluation of the problem by the
surgeon to determine the need for surgery [procedure];
Treatment for the underlying condition or an added course of
treatment, which is not part of normal recovery from surgery;
• Diagnostic tests and procedures, including diagnostic radiological procedures.â€�
 

thensel

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Sorry, one other question comes up now. If the path results are reviewed outside the global period and are normal and no additional treatment is required, is this then a billable visit? Sometimes, the results take longer than 10 days to come back, and sometimes scheduling conflicts occur where the appt cannot be made within the 10 days.

Also, my doctor thinks that even suture removals done outside the 10 day global period should be billable regardless of the reason why they were not removed within the 10 day period. I have seen other providers routinely schedule these types of visits 14 days post op and bill 99212.

I am so confused here! Isn't payment for the suture removal included in the procedure whether or not it is done within the global period? Would the same be true for reviewing routine test results outside the global period?

I really do appreciate the help from the experts.
 
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Hope he looks good in orange ...

Sorry, one other question comes up now. If the path results are reviewed outside the global period and are normal and no additional treatment is required, is this then a billable visit? Sometimes, the results take longer than 10 days to come back, and sometimes scheduling conflicts occur where the appt cannot be made within the 10 days.

Also, my doctor thinks that even suture removals done outside the 10 day global period should be billable regardless of the reason why they were not removed within the 10 day period. I have seen other providers routinely schedule these types of visits 14 days post op and bill 99212.

I am so confused here! Isn't payment for the suture removal included in the procedure whether or not it is done within the global period? Would the same be true for reviewing routine test results outside the global period?

I really do appreciate the help from the experts.
If a surgeon tried this on me I would suggest that I may just report him for fraudulent billing practices. The global surgical package includes routine postoperative care - that means removing the sutures you placed is part of the surgery - and you have already been paid for that in the reimbursement for the surgery. I realize that at times you cannot get a patient in within the 10-day global period; in those caess, we STILL code that F/U visit as 99024 and do not bill it to insurance or patient.

Hope that helps.

F Tessa Bartels, CPC, CEMC
 
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