Wiki Post op visits for out of network provider

[RVOSKANI]

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?

 

[Rbmoorecpc]

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.