Post-op chemo and subsequent visits

aimes

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Any thoughts on this would be much appreciated.
We have received several denials for subsequent hospital visits as "“Pre/post-operative care payment is included in the allowance for the surgery/procedure.”
Patient had a biopsy of a mediastinal mass performed using the chamberlain procedure 39010, which has a 90-day global. Patient remained in the hospital and received Chemo the following days after. Surgery/biopsy was performed by our Thoracic MD and the follow ups were by our MED Onc MD's (two separate sub specialties).

1. Should/Can I append mods to the hospital visits? The visits did not go out with any modifiers. I feel like it needed mods since patient received chemo, which would prompt the above denial. Same denial we get if a regular E&M goes out without a mod 25 and injection/infusion done same day.
2. Are these visits considered a part of the global surgical package (because the biopsy came back malignant which is the reason for the chemo) or is it separate since the visits relates to the chemo and not the surgical procedure itself, and it is a separate MD/subspecialty seeing the patient in regards to the chemo.
I over all feel like these visits need mods, but am unsure if it needs only a 25, a 24 and a 25 or a combination of mods im missing all together or if these are just all inclusive to the global period and we have to write off.
Your help is much appreciated.
 

thomas7331

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Visits by the surgeon and/or other providers of that specialty that are for postoperative care of the surgical procedure (e.g. to evaluate recovery from the procedure, perform wound care, etc.) would be inclusive to the surgery and not separately billable. However, per the CMS global surgery guidelines, "treatment for the underlying condition or an added course of treatment which is not part of normal recovery from surgery" is not part of the global package, so if those visits involve care related to the treatment of the disease and not post-operative care, then a modifier would be appropriate.

Visits performed by providers of specialties different from the those who did the procedure that has the global period are not part of the global surgical package, and so should not require any modifiers. But if your payer is denying these as global, they may not recognize the specialties as being different, so it may be necessary to add one, as appropriate, if it is the case that the services are not post-surgical care.
 

aimes

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Visits by the surgeon and/or other providers of that specialty that are for postoperative care of the surgical procedure (e.g. to evaluate recovery from the procedure, perform wound care, etc.) would be inclusive to the surgery and not separately billable. However, per the CMS global surgery guidelines, "treatment for the underlying condition or an added course of treatment which is not part of normal recovery from surgery" is not part of the global package, so if those visits involve care related to the treatment of the disease and not post-operative care, then a modifier would be appropriate.

Visits performed by providers of specialties different from the those who did the procedure that has the global period are not part of the global surgical package, and so should not require any modifiers. But if your payer is denying these as global, they may not recognize the specialties as being different, so it may be necessary to add one, as appropriate, if it is the case that the services are not post-surgical care.
Thank you, when worded like this, it is much more clear to me. I appreciate your feedback so much.
 
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