Wiki Is this part of hysterectomy global care?

[cubbiecatz]

We have a patient that had a complete TLH with BSO. Patient is well within the global period and is being seen for symptoms related to menopause and the provider has ordered lab work.

Would this be billable with an E&M and modifier 24 or is this considered part of the global care and coded as 99024?


Thank you, Cathy

 

[Cmama12]

Hi Cathy, these are my thoughts... when I look at the global surgical package information under Included it states " Postoperative Visits - Follow-up visits during the postoperative period of the surgery

that are related to recovery from the surgery;". Under Not Included it states " Treatment for the underlying condition or an added course of treatment which is not

part of normal recovery from surgery". In my opinion, as the surgery would have put her into menopause, which would be known ahead of time, I would say this visit is a normal part of recovery from this surgery.

 

[cubbiecatz]

Hi Cathy, these are my thoughts... when I look at the global surgical package information under Included it states " Postoperative Visits - Follow-up visits during the postoperative period of the surgery

that are related to recovery from the surgery;". Under Not Included it states " Treatment for the underlying condition or an added course of treatment which is not

part of normal recovery from surgery". In my opinion, as the surgery would have put her into menopause, which would be known ahead of time, I would say this visit is a normal part of recovery from this surgery.

Thank you, Meg! I originally sent it to the provider stating this is normal or expected symptom after a hysterectomy and the provider has countered saying the patient had a diagnosis of endometriosis and sent me an article from a provider addressing why endometriosis follow up is allowed. She does mention a left lower quadrant pain, but her final diagnosis and plan states the LLQ pain is probably GI related, there was no endometriosis on rectum or colon, and she has no further plan for that diagnosis other than to avoid constipation. The Menopausal symptom is the diagnosis where she has ordered hormone labs.

 

[nielynco]

Thank you, Meg! I originally sent it to the provider stating this is normal or expected symptom after a hysterectomy and the provider has countered saying the patient had a diagnosis of endometriosis and sent me an article from a provider addressing why endometriosis follow up is allowed. She does mention a left lower quadrant pain, but her final diagnosis and plan states the LLQ pain is probably GI related, there was no endometriosis on rectum or colon, and she has no further plan for that diagnosis other than to avoid constipation. The Menopausal symptom is the diagnosis where she has ordered hormone labs.

I have to agree with Meg on this one and not your provider as endometriosis is not confirmed so this is not why there is followup. Menopause is a direct result of the the surgery and blood work would be done to confirm the levels and then order any appropriate medications during the postop period. After that period is over, they patient can be seen for her ongoing treatment of menopause, but in my opinion, in the postop period that care would be included as it is directly related to the surgery and the patient's recovery from the surgery.

 

[csperoni]

I'll be the voice of slight dissent here. Depending on the age and pre-surgery status of the patient, and the severity of the menopause symptoms, it MIGHT not be part of normal recovery from surgery and an added course of treatment. I would say it's likely part of the global surgical package, but not definitively. Not the scenario here, but let's say only one ovary was removed (for a cyst and not endometriosis). In that clinical picture, you would not expect surgical menopause and it would likely be outside global.
For this example, probably part of global. But each case should be evaluated individually and not a blanket always included.