Wiki post op visits during a global service

[Jmccarty]

I have a question. Patient was in the hospital for 3 days. We admitted the patient and billed for and Initial E&M 99222(25). Our provider consulted a surgical physicians and the Surgical MD did a laparoscopy appendectomy for this patient. If our pediatric hospitalist continues to see the patient after the patient had an appendectomy can we bill 99232 on the following day and 99238 on the day of discharge and what modifier would I use to explain that our fees should not be included in the global package. My understanding is that modifier 55 is not applicable to E&M services. Is there another modifier that I can apply to our services?

 

[OCD_coder]

There is no medical necessity o follow the patient postoperatively such as a comorbidity disclosed in your posting to support concurrent care, regardless if the physicians are in different specialties and clinics. Medicare is looking at concurrent care a little closer for this type of billing. My question is why was a modifier 25 appended to the E&M 99222 when a major surgery was performed (Mod-57)?
Obviously a transfer of care was performed to the surgeons to do the appendectomy.

I realize that you stated "Pediatric hospitalist" and Medicare may not be involved, but commercial carriers also have "medical necessity" requirements.

 

[pezztx]

A: Why is there a modifier 25 (like asked above)?
B: If your physician didn't do the sx, there should be no concern of global, right?

I could be mistaken.