• If this is your first visit, be sure to check out the FAQ & read the forum rules. To view all forums, post or create a new thread, you must be an AAPC Member. If you are a member and have already registered for member area and forum access, you can log in by clicking here. If you've forgotten the password it can be reset on our sign in section by entering your registered Email Address or Username here. To start viewing messages, select the forum that you want to visit from the selection below..

Post op visits for out of network provider

R

RVOSKANI

Guest
Messages
11
Hello,

Our surgeon is out of network with all insurances except Medicare, who he is contracted with.

Question: are we able to bill insurances for "post op" visits within global period after a surgery to a provider we are noncontracted with? After all, we get to set the rules because we are out of network, correct?
 
Reply to post op

Just because you are out of network, each CPT code has a certain number of global days attached to it. This is set by CPT and has RVU's attached to make up for the work involved with the surgical procedure. Major procedures have 90 days global post op days while minor surgeries usually have 0-10 days. The only way that your MD could charge during a post op period is if he/she encounters a complication that would send them back to the OR or if the visit has nothing to do with the surgical procedure. Keep in mind that ethics plays a huge part in this and quality of care should be top on the list. :eek:
 
You must log in or register to reply here.
Top