global period

amatoj16

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merrick, NY
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My doctors is a podiatry and sometimes they are on call and they do surgeries in the ER. There are times that we are not in network with the patients insurance, so the doctor wants to send the patients to wound clinic instead of seeing the patient for the 90 day global period. Is that legal to do? I though we had to see them for the global period. I appreciate some feed back on this .
 

thomas7331

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It is legal, but if the physician is going to be transferring care to another physician for the post-operative care, then he or she should bill the surgery with modifier 54 to indicate that they are billing for operative care only. That way the payer will reimburse your physician only for the surgery and not for the post-operative portion.

The instructions on the use of these modifiers in this situation are on page 9 of Medicare's Global Surgery Booklet, which you can find here:

 
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amatoj16

Contributor
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Location
merrick, NY
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It is legal, but if the physician is going to be transferring care to another physician for the post-operative care, then he or she should bill the surgery with modifier 54 to indicate that they are billing for operative care only. That way the payer will reimburse your physician only for the surgery and not for the post-operative portion.

The instructions on the use of these modifiers in this situation is on page 9 of Medicare's Global Surgery Booklet, which you can find here:

thank you
 
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