hospitalist/ortho coding

Messages
4
Location
Riceville, TN
Best answers
0
ortho surgeon perfoms THA. pt has no other active conditions.
ortho wants the hospitalist to do H&P and subsequent hospital visits.

is this unbundling? doesn't code 27130 include H&P and subsequent hospital visits?

any help is appreciated!

Thanks,
Joy:
 

mitchellde

True Blue
Messages
13,538
Location
Columbia, MO
Best answers
2
IF your surgeon wabts to do it this way then you must bill your surgical code with a 54 modifier to show you provided the surgical service only. The hospitalist then should bill the H&P with the 56 and the post op with the 55, then it is not double dipping, it is unbundleing the global the way it was meant to be unbundled. You cannot however bill for the entire global (no modifier) and then request another provider do the pre and the post visits, that is double dipping.
 
Messages
4
Location
Riceville, TN
Best answers
0
Thanks Debra! Can you point me to any documentation re: this? would it be the NCCI edits? is there something documenting the discounted fee for using the 54?

Thanks again!
 

mitchellde

True Blue
Messages
13,538
Location
Columbia, MO
Best answers
2
It is in the description of the modifiers, If you are providing only the surgical service then you must append the 54 that is its purpose. You can also check the federal register or google search with key term split global billing. Also Medicare has a section in the Mcare manual on split care billing, as well as Blue cros and United provider manuals.
 
Top