Postoperative Visit vs Treatment for Underlying Condition

drewvinson23

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Vancouver, WA
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Hoping to get some other people's input on this scenario.

I have a physician that recently posted this question to me:

"If I see a patient and do an independent interpretation of a KUB during the global period of an ESWL, is that visit billable?"

Per CMS global surgical package guidelines, my first initial thought would be that this is not billable, as it is related to the recovery from surgery.

However, could this evaluation and management service with the independent interpretation of an image be seen as "treatment for the underlying condition" (the condition being kidney stones), and therefore billable? I have had difficulty finding any guidance or quantifying what constitutes "treatment for the underlying condition." The doctor is interpreting the KUB to see if further treatment will be needed. Is that enough to qualify this as "treatment for the underlying condition" and make this a billable service?
 

trarut

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That's a tricky one but my gut reaction is that it's part of the postoperative follow-up. Your provider is assessing the response to surgery, not treating the underlying condition.
 

csperoni

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I agree with @trarut. I've never seen guidance that specifically provides this exact scenario, but this seems to be part of the postop. If you were to evaluate the note, eliminating everything that was postop, would you have enough to level a visit? Unless the KUB showed some other condition/problem, I would consider reading the KUB evaluating the kidney stones, not treating the kidney stones.
 
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