Wiki Medicare Post Op Management Only

[ambercooney]

My question is, we billed a 27245 with a Modifier 55, as the patient was initally treated in another state. Medicare requested all of our documentation, which was sent and claim still denied for further notes. We do not have a transfer of care or copy of op report and have not been able to obtain from the hospital or by requesting the patient to do so. One of our billers would like to just bill it with an E/M code for payment and be done with it. I said that if we do Medicare will deny as care provided by another provider in the global period- I know this office has tried this before on other patients, but I am looking for documentation to back that up. Any help would be appreciated.

Thanks
Amber

 

[FTessaBartels]

Do you have the name of the surgeon?

If you have the name of the surgeon who performed the procedure, can you get the notes from that office?

I'm guessing that what happened is that surgeon did NOT use the -54 modifier (as s/he should) and has been paid the full fee already.

You could just bill the E/M visits and they should be payable. You did not perform any surgery so no global period applies to you.

Sorry I can't be more helpful.

F Tessa Bartels, CPC, CEMC

 

[ambercooney]

Thank you, and no I have been unsuccessful at getting the Op report either through the hospital or the name of the surgeon since all of this was done out of state, the patient has been unable to assist us as well.

Amber