Observation consult then office visit next day

Kestrelwa

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I need your opinion please

Medicare Patient is seen in ER on Sunday, has reduction of fracture and then admitted to Observation. On Monday Ortho doctor is called to consult on the pt in the Observation area, 99213. Ortho dr. decides the pt needs pinning sometime this week. The pt is discharged home from observation. The next day, Tuesday, the pt is seen in the Ortho clinic and the Ortho Dr evaluates pt again, 99213. Surgery is planned for Thursday of the same week.

My question is can this doctor bill for his consult in the Observation and then again the next day in the clinic? He wants to bill 99213 for both visits.

Thanks for your help!!

Lori
 

LindaEV

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Did your doc do the reduction? If so, isn't there a global period associated with that, and susbsequently no visits allowed at all.

If he did not do the reduction, then he was called in for consult, the you can bill both visits. (maybe a new patient visit for the consult???)
 

Kestrelwa

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The ER doctor performed the reduction. I wish it was as simple as being in global. Thanks for your help!
 
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Milwaukee WI
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ER consult ONLY

He only gets to bill for one pre-op visit, the one where he made the decision for surgery.

He made the decision to perform surgery at the ER consult. Any visit after that is global to the surgery.

Hope that helps.

F Tessa Bartels, CPC, CEMC
 
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