Wiki Procedure done in ED, specialist follow-up

[anastasia213]

We have a patient that had a procedure performed in the Emergency Department (27550). The patient was advised to followup with the Orthopedic specialist. All of the follow up visits are denying as global to the procedure.

Shouldn't these visits be reimbursed since the specialist (nor anyone in his office) did not bill for the procedure?


Stacey

 

[charissesimone]

We have a patient that had a procedure performed in the Emergency Department (27550). The patient was advised to followup with the Orthopedic specialist. All of the follow up visits are denying as global to the procedure.

Shouldn't these visits be reimbursed since the specialist (nor anyone in his office) did not bill for the procedure?


Stacey

The procedure may be based off E/M guidelines for follow-up within a global period as included in the global fee -it couldn't be billed separately.

The global surgical package includes a preoperative evaluation and management (E&M) service on the day of the procedure (unless the E&M meets the criteria for a -25 or -57 modifier), the intraoperative work, and the follow-up service for a set number of global days. Minor surgical procedures typically have zero or 10 global days. That is, if the service has 10 global days, any follow-up care related to that procedure for 10 days is included in the fee for the service; you can't bill separately for it. If a procedure has zero global days, no follow-up care is included in the fee for the service.

http://www.physicianspractice.com/display/article/1462168/1592062

 

[Donna T]

I think you misread the original post - the specialist did not treat the original fracture as it was diagnosed and treated in the ER. If the specialist is only doing the postoperative management then he could bill for it using the original procedure code and a -55 modifier.