Wiki Help with global period!

[wyatt313]

Patient had an ESWL in another city by her urologist. 10 days later she ended up in the hospital in our city with obstruction in her ureter from the stone fragments, UTI and sepsis. My urologist admitted her, exchanged her stent the same day and then 3 more progress notes. Even though we did not do the ESWL I did not think we could charge the E/M visits because of the 90 day global for the ESWL. He tells me we can with the appropriate post-op modifier because he didn't do the ESWL so it is not our global package. I think he is thinking modifier 55. I don't know what to do. I don't think she was seen for a separate issue since her obstruction seems as though a result of the ESWL to me. Please help!

 

[thomas7331]

My understanding is that the global period only applies to the surgeon who performed the original procedure (or covering physicians). From the Medicare guidelines, the global period 'includes payment for the following services related to the surgery when furnished by the physician who performs the surgery.' Services that are excluded from the global period and paid separately include those 'of other physicians except where the surgeon and the other physician(s) agree on the transfer of care.' If your provider is in a separate practice that does not have a coverage agreement with the practice of the original surgeon in this case, then the services are not global and should not require a modifier.

Thomas Field, CPC, CEMC