Hospital Consults for return Patient in Post Op

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My Ortho doctor has had a couple patients that he did surgery on for fractures. The patients have had a fall and were admitted back into the Hospital and our ortho was called to to consult the patients who now are needing a second surgery. Is still possible to bill In Patient visit? It is a new fall but still might be considered related to the initial surgery.
 

Orthocoderpgu

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As professional coders we need to use words that accurately reflect our thoughts and situations. You have used the word "Consult". Unless all three requirements for a consultation has been met and documented, that word should not be used as it gives the impression that you plan on billing a consultation code which is inaccurate for this situation. Having said that, your physician can bill the appropriate E/M code with modifiers for this situation. Because the patient fell and injured themselves it now becomes a "new" issue with its own treatment plan.
 
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csperoni

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If the patient was admitted for a complication of the original surgery that does not result in a return to the OR, that is part of the global package. In your scenario, that is not the case and these visits are billable. Below is an excerpt from the Medicare Global Surgery booklet (full link https://www.cms.gov/outreach-and-ed...oducts/downloads/globallsurgery-icn907166.pdf) with relevant lines bold and italic. As noted above by Orthocoderpgu, these would note be "consult", but rather IP codes.

What services are included in the global surgery payment?
Medicare includes the following services in the global surgery payment when provided in addition to the surgery:
• Pre-operative visits after the decision is made to operate. For major procedures, this includes pre-operative visits the day before the day of surgery. For minor procedures, this includes pre-operative visits the day of surgery.
• Intra-operative services that are normally a usual and necessary part of a surgical procedure
• All additional medical or surgical services required of the surgeon during the post-operative period of the surgery because of complications, which do not require additional trips to the operating room
• Follow-up visits during the post-operative period of the surgery that are related to recovery from the surgery
• Post-surgical pain management by the surgeon
• Supplies, except for those identified as exclusions
• Miscellaneous services, such as dressing changes, local incision care, removal of operative pack, removal of cutaneous sutures and staples, lines, wires, tubes, drains, casts, and splints; insertion, irrigation, and removal of urinary catheters, routine peripheral intravenous lines, nasogastric and rectal tubes; and changes and removal of tracheostomy tubes

What services are not included in the global surgery payment?
The following services are not included in the global surgical payment. These services may be billed and paid for separately:
• Initial consultation or evaluation of the problem by the surgeon to determine the need for major surgeries. This is billed separately using the modifier “-57” (Decision for Surgery). This visit may be billed separately only for major surgical procedures.
• Services of other physicians related to the surgery, except where the surgeon and the other physician(s) agree on the transfer of care. This agreement may be in the form of a letter or an annotation in the discharge summary, hospital record, or ASC record.
Visits unrelated to the diagnosis for which the surgical procedure is performed, unless the visits occur due to complications of the surgery
• Treatment for the underlying condition or an added course of treatment which is not part of normal recovery from surgery
• Diagnostic tests and procedures, including diagnostic radiological procedures
• Clearly distinct surgical procedures that occur during the post-operative period which are not re-operations or treatment for complications Note: A new post-operative period begins with the subsequent procedure. This includes procedures done in two or more parts for which the decision to stage the procedure is made prospectively or at the time of the first procedure.
• Treatment for post-operative complications requiring a return trip to the Operating Room (OR). An OR, for this purpose, is defined as a place of service specifically equipped and staffed for the sole purpose of performing procedures. The term includes a cardiac catheterization suite, a laser suite, and an endoscopy suite. It does not include a patient’s room, a minor treatment room, a recovery room, or an intensive care unit (unless the patient’s condition was so critical there would be insufficient time for transportation to an OR).
• If a less extensive procedure fails, and a more extensive procedure is required, the second procedure is payable separately.
• Immunosuppressive therapy for organ transplants
• Critical care services (CPT codes 99291 and 99292) unrelated to the surgery where a seriously injured or burned patient is critically ill and requires constant attendance of the physician
 
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Thank you. I agree my initial wording consult would not be what I had intended to code or bill. When my doctor is the Trauma Orthopedic on call, that is how the request comes over from the hospital either by the floor or ER, requesting a consult. This would indeed be billed as an IP visit, my doctor and I kind of went back and forth if this could be billed. I let him know it could but he didn't think I should bother. Thank you for this information.
 

Orthocoderpgu

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Thank you. I agree my initial wording consult would not be what I had intended to code or bill. When my doctor is the Trauma Orthopedic on call, that is how the request comes over from the hospital either by the floor or ER, requesting a consult. This would indeed be billed as an IP visit, my doctor and I kind of went back and forth if this could be billed. I let him know it could but he didn't think I should bother. Thank you for this information.
I would surprise him and bill it for him. He won't be dissapointed. You can use the -24 & -57 modifiers to show that this is a new condition in a global period.
 
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That is the modifiers that I knew could be used for the IP visit to determine the Surgery needed. Of course he is the type that needs to see things in black and white so I will be happy to show him it can be done. Thank you again
 
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