Wiki Inpatient consult then surgery after patient is stable ?

[cpccoder2008]

A patient is admitted through Internal Medicine and Surgery is consulted and the decision for surgery is made but not until the patient's current condtion is stable ( dm, htn etc. ) I have read somewhere's that all other subsequent visit's are not billable once the decision for surgery is made. I am trying to find some clarifaction on this for my surgery physician's.

 

[LLovett]

Good luck finding a clear answer.

I have been researching this for awhile. There is a policy that clearly states aside from the decision for surgery all over visits during a medicare covered stay in which the surgery was done are included in the global fee.

http://www.cms.hhs.gov/Transmittals/Downloads/R954CP.pdf

When asked directly our carrier, WPSMedicare, danced around it and said that since the policy doesn't specifically address the time period between decision for surgery and the offical start of the global period, that we could try and bill for those services if they are medically necessary.

I wish I had a better answer to post and hopefully someone else will,

Laura, CPC

 

[cpccoder2008]

I found this article but i still don't think it's sufficient enough to show my physician's. According to the article once the decision is made then all other visit's are considered global, which i understand, but if the surgeron is still following the patient along with the Internal Medicine doctor's to evaluate and manage their current condition it seem's that would be something we could bill.
http://www.physicianspractice.com/index/fuseaction/articles.details/articleID/380/page/4.htm

The surgeon would only report the subsequent hospital care visits if they are medically necessary and the surgeon is contributing unique services to the patient.