Wiki OPIB during Global Surgical Period

[venitacason]

Hi, friends! Question for all of you Global Surgical Period experts

*****Background*****
Patient is OPIB (outpatient in bed or bedded outpatient status) who is neither inpatient nor observation but is occupying a bed in the hospital....

*****Scenario 1*****
Patient just had surgery and I, as a hospitalist, accepted transfer of care from the surgeon in a formal agreement.
Patient is seen by me overnight (reminder patient is OPIB) I will submit claim as follows
CPT 99024
Modifier 55
POS 22

(I believe this would be correct)

*****Scenario 2***** HELP!
Patient just had surgery and I, as a hospitalist, am consulting on the patient (just checking that they're OK). There was no formal transfer of care and nothing is wrong with the patient....patient can go home in the morning. Reminder that patient is OPIB. I will submit the claim in one of the following ways (WHICH WAY?!)

1) CPT 99024, Modifier ?, POS 22
or
2) CPT 99203, No modifier, POS 22

and if you chose 99203 (new patient office visit) - why?

 

[carolhodge]

In either case, without knowing the level of history, exam and medical decision making documented, I can't pick one. In the second scenario, if there was no formal transfer of care and nothing wrong with the patient, I would question why you were seeing the patient. I'm sorry I couldn't be of more help.

 

[thomas7331]

I agree, it is a little hard to understand what is going on here and to recommend coding.

In the first example, a formal transfer of care is normally done to another provider of the same specialty who agrees to take over ALL postoperative care for the patient. You would not transfer care for just one day. The provider accepting transfer of care would bill the surgical code (not an E&M code) with modifier 55 and would receive payment for the entire postoperative portion of the surgery - the surgeon in this case would need to bill modifier 54 and receive a reduced payment. This situation does not sound like a true transfer of care unless the hospitalist is truly going to follow the patient throughout the entire global period. In the second situation, I agree with the post above: why is this provider seeing the patient? A consultation is not to just check in on a patient - a consultation is a request to another specialist to evaluate and manage a specific problem.

To be honest, in both examples it sounds like this surgeon is just passing off a routine post-op visit to a hospitalist. Since routine post-op care is a part of the surgical payment, this should not be separately billed (or can be billed with 99024 with no charge). If the hospitalist is expecting compensation for this service and not doing it as a courtesy, then they should make an arrangement for this directly with the surgeon, since they are doing the surgeon's work for which the surgeon will be reimbursed by the payer.