Wiki Is it really a global visit?

Create Wiki
C

Cyndi113

True Blue
Messages
629
Location
Maricopa, Arizona
Best answers
0
Our office is plagued by do we bill a global or not? We have all read the Sept Coding Edge and still have questions.

Patient is scheduled for a post procedural f/u. However, has been experiencing diarrhea and secondary dehydration. These are not related to the procedure and therefore we bill an E/M. CC by the provider is diarrhea with supporting doc to bill a 99213.

If we go by the intent (scheduling), this should be a global visit. However, the provider did a very, VERY cursory comment of checking that the diarrhea was not related to the procedure and the full documentation was related to the new problem.

Opinions?? Comments?? Discussion?? HELP!

Thanks so much,
 
Cindi,

If the diagnosis is unrelated to the surgical procedure then you would need to us mod 24 on the E/M code to bill the claim.

SVanhorn:)
 
I think you are fine in billing this with a 24 if it is not related to the surgery.

There is nothing wrong with the patient coming for one reason and another problem being discovered/brought up while they are there. As long as there is enough to support the problem visit on its own, you should be fine.

You need to be careful though, and have at least 2 of the 3 key components on the problem. I have surgeons that will deal with other issues during post op follow ups but they only document the MDM portion so even though it could be billable there is not enough documentation to support it. Or sometimes they will get the history piece and don't bother to include it in the A&P.

These visits really need to be looked at case by case, in my opinion anyway. They are on the OIG hitlist and RAC is also looking for E/M during the global period.

We need to get credit for what we are doing, and I don't have a problem raising red flags, if what we are doing is correct.

Just my opinion,

Laura, CPC, CEMC
 
You must log in or register to reply here.
Top