Wiki G0559

[jeskla]

Does anyone know if this would apply to fracture care codes (with manipulation) where the patient was not taken to the OR? I wasn't sure if this code applied to all codes with a 90 day global period or only after operating room procedures. It states "post operative" in the code description so I am thinking no.

G0559

Postoperative follow-up visit complexity inherent to evaluation and management services addressing surgical procedure(s), provided by a physician or qualified health care professional who is not the practitioner who performed the procedure (or in the same group practice) and is of the same or of a different specialty than the practitioner who performed the procedure, within the 90-day global period of the procedure(s), once per 90-day global period, when there has not been a formal transfer of care and requires the following required elements, when possible and applicable:

 

[JDACPC]

Does anyone know if this would apply to fracture care codes (with manipulation) where the patient was not taken to the OR? I wasn't sure if this code applied to all codes with a 90 day global period or only after operating room procedures. It states "post operative" in the code description so I am thinking no.

G0559

Postoperative follow-up visit complexity inherent to evaluation and management services addressing surgical procedure(s), provided by a physician or qualified health care professional who is not the practitioner who performed the procedure (or in the same group practice) and is of the same or of a different specialty than the practitioner who performed the procedure, within the 90-day global period of the procedure(s), once per 90-day global period, when there has not been a formal transfer of care and requires the following required elements, when possible and applicable:

Everything I have seen only mentions 90-day global procedures, no requirement of only OR procedures, not used for 0- or 10-day global procedures.

 

[natashalage]

Could somebody please give me an example of when we could use this Complexity code? it's confusing to me. I understood that we can use G0559 when it's within 90 days global, "by the same or of a different specialty", when there is no a formal transfer of care is done. But .. if it's a different specialty, then I can use G2212 complexity for outpatient e/m?! If it's the same specialty, then I can not use 99202-99215 (like it recommends) because it's within 90 days global = 99024? I am confused... Will greatly appreciate your example of using G0559. Thank you!

 

[csperoni]

Could somebody please give me an example of when we could use this Complexity code? it's confusing to me. I understood that we can use G0559 when it's within 90 days global, "by the same or of a different specialty", when there is no a formal transfer of care is done. But .. if it's a different specialty, then I can use G2212 complexity for outpatient e/m?! If it's the same specialty, then I can not use 99202-99215 (like it recommends) because it's within 90 days global = 99024? I am confused... Will greatly appreciate your example of using G0559. Thank you!

My understanding of G0559 is when a patient chooses to transfer care, but there is not a formal transfer of care by the initial (surgical) clinician.
Example:
Patient has ovarian cystectomy performed by OBGYN1 and instructed to follow up in 2 weeks. Patient decides she didn't like OBGYN1 (or the office is too far, or the hours are inconvenient, or basically any reason) and decides to instead see OBGYN2 in a different practice. OBGYN1 was expecting and willing to provide the global surgery package, so didn't transfer care and billed as usual. OBGYN2 would bill 99202-99215 (because they are not part of OBGYN1's practice) AND G0559. The G0559 is for "hey, you did extra work by obtaining/reviewing other doctor's op note, and pathology, and you picked up where they left off."
I would imagine this is not something encountered regularly, but there is now a code for the extra work the second doctor does related to the surgery by another physician.

G2212 is for extended care and a completely different situation/scenario.

 

[natashalage]

Thank you so much Christine for the detailed explanation of the situation when we can use this code! So many codes to remember! I like simplicity but I feel like the AMA keeps creating codes and more codes to makes our life So complex. Crazy. Thank you again.