Wiki Global Period Coding?!?! I need help!!

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asims2008

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My name is Ashley Sims...and I work at a cardiology clinic in Jackson, TN. We have been getting a lot of denials on hospital and office visits that are subsequent to procedures that have a 90 day global period...stating that the visit is bundled with the procedure...my office manager wants me to add a -24 modifier to the e/m and change the dx codes so that we will get paid...I have gotten with him numerous times and told him that this cannot be done unless the visit is for something completely different but these patients are being seen specifically for hospital follow up and the dx codes are the same...so he decided that he would try to hire another doctor to do the visits after a procedure and try to get it paid that way...but I have been told that this will also be considered bundled...so now he is rescheduling all office visits for 91 days after a procedure...is this something that can be done and I am coding this correctly?? Is there some other way that I can code this that will get it billed because he seems to think that there is! I am having so many problems with this but I really feel that I am correct on this one and that this bundled and that there is no way to unbundle it!
 
Can you say FRAUD! You are correct. You cannot change a dx on a f/u visit just to get paid... surgical f/u visits within the 90 day global period are not payable unless the patient is seen for a different problem and is not a related complication of the surgery.

Here is the link to the Medicare on-line manuals for the global period.
CMS Pub. 100-04, Chapter 12, Section 40.2.-40.5 (PDF, 979 KB)


Hope this helps you,

Dolores CCC, CPC
 
asims2008 said:
My name is Ashley Sims...and I work at a cardiology clinic in Jackson, TN. We have been getting a lot of denials on hospital and office visits that are subsequent to procedures that have a 90 day global period...stating that the visit is bundled with the procedure...my office manager wants me to add a -24 modifier to the e/m and change the dx codes so that we will get paid...I have gotten with him numerous times and told him that this cannot be done unless the visit is for something completely different but these patients are being seen specifically for hospital follow up and the dx codes are the same...so he decided that he would try to hire another doctor to do the visits after a procedure and try to get it paid that way...but I have been told that this will also be considered bundled...so now he is rescheduling all office visits for 91 days after a procedure...is this something that can be done and I am coding this correctly?? Is there some other way that I can code this that will get it billed because he seems to think that there is! I am having so many problems with this but I really feel that I am correct on this one and that this bundled and that there is no way to unbundle it!
Click to expand...

Wow! You can't do that! Good eye. And thanks Delores for the Global info. I want to read up on that as well.
 
Wow! It sounds like your manager needs to learn about fraud and the consequences of it.

Becky Coffman, CPC
 
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Evaluation and Management Services During Global Surgery Periods

We will review industry practices related to the number of E&M services provided by physicians and reimbursed as part of the global surgery fee. CMS’s Medicare Claims Processing Manual, Pub. No. 100‐04, ch. 12, § 40, contains the criteria for the global surgery policy. Under the global surgery fee concept, physicians bill a single fee for all of their services that are usually associated with a surgical procedure and related E&M services provided during the global surgery period. We will determine whether industry practices related to the number of E&M services provided during the global surgery period have changed since the global surgery fee concept was developed in 1992.
(OAS; W‐00‐09‐35207; various reviews; expected issue date: FY 2011; work in progress)

This is definitely being monitored by the OIG!

http://oig.hhs.gov/publications/workplan/2011/WP01-Medicare_A+B.pdf

Page 19

Main site:

http://oig.hhs.gov/reports-and-publications/workplan/index.asp#current
 
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