Question Orthopedic Billing

TJAlexander

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I've just started with a new orthopedic practice with an orthopedic surgeon who specializes in sports medicine. I have a question regarding the services he provides at the hospital. I will be submitting claims for the surgeries he performs. Since the majority of the procedures are considered to have an 11 or 92 global period, am I able to bill for subsequent day evaluations at bedside? Also, will I need to submit claims for the surgeries using PCS coding since his patients are inpatients?? This is all very new to me so sorry for sounding clueless!
 

lfollebout

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The postoperative care provided to the patient is included in the surgical fee until the global period expires. He may submit charges for any evaluation/treatment for an unrelated problem. Coding for his procedures are from CPT regardless of the place of service.
 

TJAlexander

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Thank you. I have experience in primary care with a practice that used hospitalists to handle any inpatient care so this will be the first time I'll deal with consultations and the like so I'm a bit nervous.
 

andersol

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I have a question.. my Doctor had to discontinue a procedure due to pt went into cardiac arrest.. Im billing cpt code 27447 with modifier 53. the patient is doing much better so my doctor is going to finish the procedure at a later date. Do I bill the same procedure 27447 ?? with what modifier??? Please help
 

Rajinder_Dhammi

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I have a question.. my Doctor had to discontinue a procedure due to pt went into cardiac arrest.. Im billing cpt code 27447 with modifier 53. the patient is doing much better so my doctor is going to finish the procedure at a later date. Do I bill the same procedure 27447 ?? with what modifier??? Please help
Dear Coder,

First you need to understand, 27447 always takes place in an ASC (Ambulatory Surgical Center) setting which warrants you to use PLACE OF SERVICE as 24.

Now coming back to the modifier part, use modifier 73 (Prior to the adminitration of Anesthesia) or 74 (After the adminitration of Anesthesia) in accordance to the information provided in the surgical report.

Rationale for not using 53 modifier: As it has not happened in an office setting.

Please bill both date of services, as doctor deserves the money for whatever efforts he puts in.

First visits as: 27447-73 or 74 + LT or RT (use 78 or 79 modifier as well if the patient is in global period)
Second visit as: 27447 with modifier LT or RT (use 78 or 79 modifier as well if the patient is in global period)

If you need any other assitance, please don't hesitate to contact me.

PS: Also, kindly keep me apprised of the status of these two claims. I hope you get the payments for them. :):)

Rajinder Singh Dhammi, CPC
rajinder_dhammi@yahoo.com
 

katemae84

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First you need to understand, 27447 always takes place in an ASC (Ambulatory Surgical Center) setting which warrants you to use PLACE OF SERVICE as 24.

Now coming back to the modifier part, use modifier 73 (Prior to the adminitration of Anesthesia) or 74 (After the adminitration of Anesthesia) in accordance to the information provided in the surgical report.

Rationale for not using 53 modifier: As it has not happened in an office setting.
I'm going to have to disagree with the previous post.

27447 does not always take place in an ASC, it can be done as an outpatient or inpatient surgery in any operative facility. If it was done at an ASC, then yes, your place of service will be 24. If done at a hospital with surgical services, you'll want to use the place of service that reflects the patient's status at the time of surgery (place of service 22 for outpatient, 21 for inpatient).

Modifiers 73 & 74 are for use on facility claims- not for a physician's professional services. Modifier 53 is used on professional claims when a procedure is discontinued due to the patients well-being or intolerance of procedure. It's use is not tied to the place of service and can be used whether the procedure is in-office or the hospital.

Your first charge for the discontinued procedure will be 27447 with a 53 modifier. If the physician elects to finish the procedure during the global period of the first attempt (within 90 days) then you will bill 27447 with a 58 modifier. If done outside the global period of the discontinued procedure, then you'd just bill the 27447.
 

kellymb

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I'm going to have to disagree with the previous post.

27447 does not always take place in an ASC, it can be done as an outpatient or inpatient surgery in any operative facility. If it was done at an ASC, then yes, your place of service will be 24. If done at a hospital with surgical services, you'll want to use the place of service that reflects the patient's status at the time of surgery (place of service 22 for outpatient, 21 for inpatient).

Modifiers 73 & 74 are for use on facility claims- not for a physician's professional services. Modifier 53 is used on professional claims when a procedure is discontinued due to the patients well-being or intolerance of procedure. It's use is not tied to the place of service and can be used whether the procedure is in-office or the hospital.

Your first charge for the discontinued procedure will be 27447 with a 53 modifier. If the physician elects to finish the procedure during the global period of the first attempt (within 90 days) then you will bill 27447 with a 58 modifier. If done outside the global period of the discontinued procedure, then you'd just bill the 27447.
So when a procedure is discontinued, the global fee period still applies?
 
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