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Post Op Care

Ltubia

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I have a provider that recently left employment at a local facility. He is now in a group practice we bill for. My question is how to take care of his post op patients. Should we be billing E/M codes with modifier 55 or should we bill 99024? My issue is that the facility got paid for his taking care of the patients from pre op to surgery to post op, however, he isn't doing that post op care under their tax ID#. If you can refer me to specific citations about this, I would appreciate that as well.
 

mbirman

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Modifier 54, 55, or 56 may not be billed unless the written agreement exists.
The facility already got payment, a global fee. IMHO (I am CPC-A) calculate post op percentage of global fee and bill the facility. look for global split table on the Medicare Physician Fee Schedule Relative Value File.
Regards,
M Birman
 

mitchellde

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if the provider was a salaried employee of the facility then he has already been paid for this patient's care via his salary, if the provider was not a salaried employee then his services were billed separate from the facilies and he was reimbursed what he was suppose to get. Either way this service has been paid out and to all the appropriate persons their share went. It should have been a part of the employement agreement when this provider was hired as to how current and ongoing patients would be handled, if this was not thought of ahead of time there is nothing you can do now. You cannot bill the insurance nor the patient any amount other than what has already been billed out and paid and you cannot bill the hospital since they do not get paid a global amount.
 
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