Wiki Interpeting Global

[Mjones7]

I have an issue and would appreciate your insight. I have some MD's who bill pre op visits as E/M's and I have others who bill what we call an N/C. I am attempting to streamline. I suggested we bill an E/M for pre-op services done prior to one day of surgery without a -57 as it should not be warranted as we are not in a defined global period. In the event the pre-op is performed the day of, I would bill an E/M with the -57. My Docs state they spend a great deal of time in their pre op encounters. I would like to capture the reimbursement but want to do it the correct way. I have reviewed the following:

CMS Physician Manual (Rev. 1716, 04-24-09)
C. CPT Modifier “-57” - Decision for Surgery Made Within Global Surgical
C. CPT Modifier “-57” - Decision for Surgery Made Within Global Surgical Period
Carriers pay for an evaluation and management service on the day of or on the day before a procedure with a 90-day global surgical period if the physician uses CPT modifier “-57” to indicate that the service resulted in the decision to perform the procedure. Carriers may not pay for an evaluation and management service billed with the CPT modifier “-57” if it was provided on the day of or the day before a procedure with a 0 or 10-day global surgical period.

Here is the link to the manual in its entirety http://www.cms.hhs.gov/manuals/Downloads/clm104c12.pdf

I thank you in advance for your time and reply.

 

[LLovett]

Ok the first thing jumping out to me is the use of the word "pre-op". Modifier 57 indicates the decision for surgery was just made at this visit, it is not a scheduled pre-op visit. The pre-op visit by the surgeon is included in the reimbursement of the surgery itself unless it is billed with the modifier indicating it was not done.

It sounds to me like your providers not wanting to charge are correct on this one. Using 57 to get around the global period would be incorrect in the case of a pre-op visit. 57 is when they are seeing the patient and decide we need to do surgery and that surgery happens within 24 hours.

Laura, CPC, CPMA, CEMC

 

[Mjones7]

Thank you for replying Laura. I agree with you but let me just clarify. In instances where pre operative services are performed let say 3 days to a week prior to surgery, I am suggesting we bill an E/M based on my interpetation of CMS's global period beginging the day of or one day prior to the surgery. You insight is most appreciated.

 

[FTessaBartels]

No getting around the global

Machell,
If you see patient on June 3rd and decide the patient needs surgery, which you schedule for July 10th. And then you have patient come back to the office on July 2 for a pre-op visit so your doctor can do the H&P documentation ... you should NOT be billing for a separate E/M service for that pre-op visit on July 2.

I know it is more than 24 hours prior to surgery.

But what is the medical necessity for the visit? There is none.

The RVUs for the surgery already includes the pre-operative evaluation of the patient. Your doctor is already getting paid for doing this work. To charge separately for it just because you schedule the visit outside the "official" global period is incorrect (and some would say, fraudulent).

And if you perform the pre-op visit the day before surgery you should NOT separately code it, even with a -57 modifier ... the decision for surgery was made back at the first visit.

Hope that helps.

F Tessa Bartels, CPC, CEMC

 

[Mjones7]

Machell,
If you see patient on June 3rd and decide the patient needs surgery, which you schedule for July 10th. And then you have patient come back to the office on July 2 for a pre-op visit so your doctor can do the H&P documentation ... you should NOT be billing for a separate E/M service for that pre-op visit on July 2.

I know it is more than 24 hours prior to surgery.

But what is the medical necessity for the visit? There is none.

The RVUs for the surgery already includes the pre-operative evaluation of the patient. Your doctor is already getting paid for doing this work. To charge separately for it just because you schedule the visit outside the "official" global period is incorrect (and some would say, fraudulent).

And if you perform the pre-op visit the day before surgery you should NOT separately code it, even with a -57 modifier ... the decision for surgery was made back at the first visit.

Hope that helps.

F Tessa Bartels, CPC, CEMC

Tessa thanks for the reply and this absolutely helps and gives me clarity. Thank you so very much for your insight.

 

[amjordan]

In addition, just in case your providers push back. The May 2009 issue of the CPT Assistant addressed this same issue and it has some very good examples to use as well.