Wiki Post op visits - Trying to educate my doctors

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billybrandle1964

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Trying to educate my doctors that when they do a surgery with 10 day global they need to schedule an appointment with that 11 days instead of intentially schedul 2 weeks out then bill E/M is there any documentation I could show them
thanks
 
The easiest tool that I use is from CMS.gov

https://www.cms.gov/apps/physician-fee-schedule/search/search-criteria.aspx

Plug in the surgical CPT code & click to search.

There will be a column listed as "GLOBAL" If there is a global period, it will list 10 or 90 in this column. Obviously if there isn't a global period it will list 0.

I also use this when I need to verify if an assistant surgeon can be billed for a CPT code.

Hope that helps.
 
I'm having trouble following the question. Are you trying to say the physician is purposely scheduling routine post op follow-up to be outside the global period so they an bill an E&M? If that's the case id like to see something as well stating this is prohibited. Doesn't sound right ethically and disrespectful to the patients who have to pay for the follow-up that should be included by their coinsurance or deductible amount already paid for the procedure.

If you are trying to figure out the period take the advice above.
 
post op

Yes the doctor is purposefully having patients come back after global period is over. we have 8 doctors right now and this one is one of the owners. was hired to make everyone compliant but now feel like hands are tied. they say they want compliance but do they really. frustrated
 
The patient is entitled to post op encounters as a part of the surgical service. If the scheduling does not allow this to happen the the visit is still considered to be in the global service. If the patient did not return for a scheduled global visit and then requested a visit out of the global that would be different. It will be a quality of care issue to purposely delay a post op check just for billing.
 
We are having the same problem. Our doctors are doing excision of nail 11750 and having the patients come back 11-15 days out for a recheck so they can charge an OV for the post op appointment rather than a no charge they used to do a week after the procedure. I would love to find some documentation that shows them why they should not do this.
 
post-op

I know one person said this is quality of care issue but this seems fraudulent....would you agree or no?
I think there is plan in January 2017 to do away with 10 day global and 2018 do away with 90 day global. If that happens there will be reduction in reimbursement...i also heard they are going to try to boost PCP to do any follow up.
 
If they are going to continue this practice then the surgery should be billed with the 54 modifier to indicate surgery only. Look up the surgery modifiers 54, 55, 56 .. It may address your question.
 
bbrandle@advantageplan.com said:
I think there is plan in January 2017 to do away with 10 day global and 2018 do away with 90 day global. If that happens there will be reduction in reimbursement
Click to expand...

Repeal of SGR wiped that off the table. I'd categorize what the physicians doing as abuse and not fraud.


mitchellde said:
If they are going to continue this practice then the surgery should be billed with the 54 modifier to indicate surgery only. Look up the surgery modifiers 54, 55, 56 .. It may address your question.
Click to expand...

There has to be a documented transfer of care in order to take advantage of those modifiers.

https://www.noridianmedicare.com/pr...difiers_54-55_Billing_update_082709_acro1.pdf
 
You do not need a transfer of care to use the 54. Only when you use the 55. The 54 will make sure that the global of the post op is not paid. Also by looking up this information you will probably get what you need to back up that you cannot delay the post op encounters just to bill for them since they have already been paid for.
 
transfer care

on wps wev site it does say: The surgeon must keep a copy of the written transfer agreement in the beneficiary's medical record under modifier 54
 
The modifier 54 is for the surgery itself and there will be no transfer of care for the surgery the transfer of care is for the 55 when post op is transfered to another provider. Unless they are also wanting the 56 employed for pre op and need to show that the pre op provider transfered care to a surgeon.
 
post-op

OK thanks. I am to have a discussion on this next week. I am trying not to make this a big deal but my conscious won't let it go. I want to do what is right!
 
awesome article

AAOS Now , article "check your schedule for an audit time bomb"....correctly code postoperative visits outside the global period

July 2009 issue.
 
bbrandle@advantageplan.com said:
Trying to educate my doctors that when they do a surgery with 10 day global they need to schedule an appointment with that 11 days instead of intentially schedul 2 weeks out then bill E/M is there any documentation I could show them
thanks
Click to expand...

I'm sorry, but I must disagree that follow-up appointments to surgeries must be scheduled at 11 days out. Rather, I would suggest that follow-up appointments be scheduled at a length of time that is medically necessary, rather than a strict set period of time. It may be medically necessary to see a patient sooner than 11 days. What happens if there is a complication, but it was missed because the follow-up was scheduled too far out, just so you can collect an extra office visit payment? That's not practicing good medicine, and leaves the doctor open for malpractice suits. The bottom line is every patient and situation is different, and the length of time between a procedure and a follow-up should be based on medical necessity only. If it happens to fall outside the global, then you get to bill an office visit. If it falls inside the global period, then you don't. It's that simple.
 
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