Wiki *Help* Surgical post op E/M

[tboback]

For auditing purposes I need help with this:

Scenario ONE (Doctor A Neuro Surgeon/Doctor B Spine Surgeon)
Day 1 - Patient has surgery on spine by doctor A
Day 10 - Pt has E/M with doctor A (included within surgical package)
Day 28 - Pt has E/M with doctor B for refill on Rx
Is day 28 payable?

Scenario TWO (Doctor A Spine Surgeon/Doctor B Pain Management different practice/specialty)
Day 1 – Patient has surgery on spine by doctor A
Day 10 – Patient cancels E/M with doctor A because of transportation issues and reschedules for later date.
Day 12 – Patient has E/M with doctor B (Pain Management different practice/specialty). Doctor B removes staples and refills Rx (Payable? Or included within surgical package?)
Day 20 – Patient has E/M with doctor A for surgical follow-up (Payable?)

Scenario THREE (Doctor A Orthopedic Surgeon/Doctor B Internal Med same practice MD/DO)
Day 1 - Patient has surgery on spine by doctor A
Day 10 - Pt has E/M with doctor A (included within surgical package)
Day 28 - Pt has E/M with doctor B for refill on Rx
Day 45 – Pt has E/M with doctor A for refill on Rx
Day 65 – Pt has E/M with doctor B for refill on Rx
Day 85 – Pt has E/M with doctor A for refill on Rx
Are days 28, 45, 65, 85 E/M days payable?

NEED YOUR HELP

 

[mdoyle53]

good questions and easy to answer - making the assumption that the global period is 90 days.

Scen 1 - if they are in the same practice, then it would not be payable. if not in the same practice, then it would be payable

Scen 2 - the service with the pain management doctor is payable but not the surgeon since it is within the global period.

Scen 3 - Services with the Int Med doctor would be payable but not with the surgeon.