Wiki Procedure in ED, follow with Ortho

anastasia213

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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
 
No, that wouldn't be correct. You would need to bill the insurance company the procedure code (27550)along with a -55 modifier to show that your doctor is only doing the postop care. Reimbursement will be made based on the dates that post-operative care was rendered by your physician.
 
Check with your insurance carrier regarding requirements. For Medicare you do not have to bill with 55 modifier unless there is a written transfer of care. This is per the Medicare Claims Processing Manual Chapter 12 Sections 40.1, 40.2 & 40.4. http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c12.pdf If there is no written transfer of care you would bill an E/M visit, however Medicare may deny for medical necessity.
 
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