Hospital on call rounding


Local Chapter Officer
Roseburg, OR
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I live in a small community where we have 2 orthopedic groups. Each take their turn with being on call. They round on each other's patients, and will do the initial admits during the weekend. My question is, can our providers bill a hospital E/M code if they round on a pt who has had surgery by the other group, since follow up is included in the global package? The patient will follow up with the performing provider after d/c, to receive their post surgical care. Our providers may follow those patients for several days, and some have very extensive injuries.


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This is tricky. You don't say how many physicians are in each "Group," not that it is that important, but the 2 "Groups" pretty much function as 1 as it pertains to Admission, Procedures, then Postoperative Inpatient Care. Since ultimately the patient returns to the Operating Physician for post-discharge follow-up care, which is "Global Time Frame" care, it would be very difficult for the physicians from opposite/other group to charge for "Postoperative Care" only within that Global time frame. At the very best, the physician(s) from the other group providing the Postoperative Inpatient Care could "try" charging a Subsequent Hospital Care code (99231, 99232, 99233 depending on complexity) with Modifier 55 attached. However, in reading the Descriptor for Modifier 55, it seems to "imply" that the physician picking up the postoperative care is going to assume that care fully and completely until full recovery by the patient.

I would like to see what others say to your question.

Respectfully submitted, Alan Pechacek, M.D.