Preop visit

[EHFcoding]

Hello, we would like to ask in how other practices are reporting the preop visit for elective cases when the decision of surgery was done prior, usually within a week prior to the surgery been scheduled.
Per CMS, the global surgical package, also called global surgery, includes all necessary services normally provided by a provider (or members of the same group with the same specialty) before, during, and after a procedure. Providers in the same group practice, with the same specialty, must bill and accept payment as though they’re a single physician. Medicare payment for most surgical procedures covers both the procedure and post-operative visits occurring within a global period of 10 or 90 days following the procedure. From a CMS perspective, a visit that occurs in the interval between the decision making visit and the day of the surgery, even when it may be the preoperative history and physical, is only included in the global surgery package when it is performed on the day before or the day of the major surgery as per the designated global surgery period days (i.e. 92 days) for major surgeries. However, CPT, in their Surgery Guidelines section of the CPT manual includes the same items as CMS in their definition of the surgical package except CPT does not designate procedures as “minor” or “major” and does not assign any “global days” like CMS does for every procedure. Therefore, from a CPT reporting perspective any visit related to the surgery after decision for surgery has been made is included in the surgical package.
Thank you.

 

[NRaizman]

So, yeah, you have hit the nail on the head.
These visit, particularly with non-CMS payors, are increasingly being considered part of the global and non-reimbursable, which is absurd, given that they are meaningful E&M work.

One strategy is to make the Decision Regarding Major Surgery preliminary or deferred, pending preoperative clearance and medical review. That requires ironclad documentation.

And there is -still- no real clarity on what constitutes a Major vs Minor procedure. CMS has a document that suggests that it is based on having a 90-day global, but that also has never passed muster, given that major surgeries like sinus surgery that often have subsequent debridements have 0- or 10-day globals. CPT and CMS define this differently, and every time that happens, there is friction, and private payors tend to take advantage of that and choose the guidance that allows them to pay practitioners less.

 

[EHFcoding]

So, yeah, you have hit the nail on the head.
These visit, particularly with non-CMS payors, are increasingly being considered part of the global and non-reimbursable, which is absurd, given that they are meaningful E&M work.

One strategy is to make the Decision Regarding Major Surgery preliminary or deferred, pending preoperative clearance and medical review. That requires ironclad documentation.

And there is -still- no real clarity on what constitutes a Major vs Minor procedure. CMS has a document that suggests that it is based on having a 90-day global, but that also has never passed muster, given that major surgeries like sinus surgery that often have subsequent debridements have 0- or 10-day globals. CPT and CMS define this differently, and every time that happens, there is friction, and private payors tend to take advantage of that and choose the guidance that allows them to pay practitioners less.

Thank you for your reply