Wiki pre-op global question for mitchellde

[mrolf]

Deb,

Since we are doing the pre-op physicials outside of the global surgical pkg
of 1 to 2 weeks before the surgery date and the global period states "day before or day of surgery" can we then bill a problem visit even though the patient has no chronic conditions because it really is not a preventive exam, it is an evaluation for surgery requested by the surgeon. We have always been billing a problem visit for these and I would like a definitive answer as to whether this is acceptable. In reading BCBS of NE policy I notice they do not want pre-ops billed as consults. Bill as appropriate E/M code and the V code for surgery. This question is on non-medicare patients.
Thanks

 

[mitchellde]

It is acceptable to bill as an office encounter when outside the estb global time for pre op. This not the best way as you can still face take backs in the future since technically the surgeons reimbursement includes the preoperative service. So when the payer has paid the sureon the global fee and then in tern reimburses your physician for the preop then they have paid for one part of the service twice. However having said all that, it is accepted to use just an estb patient visit level when you are outside the global.