Wiki one day post op OCT billable? proving medical necessity

[Stenglein]

One of the retinal surgeons does a routine one day post operative OCT to determine the outcome of surgery. I understand the OCT is billable when medically necessary and I do not dispute this. I have read though, when the OCT is performed, it is not billable if used to determine the outcome of surgery, unless an unfortunate outcome/event has occurred. I feel most of these are to determine the outcome. I have reached out to others and most do not do the one day post op OCT. Does anyone have any clarification on this?

 

[thomas7331]

I have not heard this - can you provide the source where you read this?

My understanding is that diagnostic tests and procedures are always excluded from the global period and can be separately billed. I've seen this in other specialties, for example orthopedic surgery, where an x-ray is done to check the alignment or the implants, and this can be billed. I only thing I think perhaps might be questionable is whether or not the surgeon should bill for the interpretation of these tests since the guidelines state that the global payment includes all "additional medical or surgical services required of the surgeon during the post-operative period" - the grey area would be whether or not the guidelines intend that an interpretation be classified as a 'medical or surgical' service.

 

[Stenglein]

I agree with your response. Unfortunately, I am unable to locate the document I was reading. Lost in the folders of my saved documents. I was reviewing retinal procedures/coding and due to the way the documentation from our surgeon appears, I was questioning. I will do more research. thank you!