Wiki Same day post op after cataract sx

[tnthekids]

Pt has cataract Sx and a one day post op is done the same day. Care is then relinquished to outside OD office. Can we bill a one day post op if patient is seen on the same day as Sx? Medicare is denying as not covered. Billed as 66984-55-LT with narrative of 7 days post op care and relinquished date

 

[saddie2k]

The transition of care would be next day, not 7 days. What date was the co-managing OD going to use for their billing? Aside from that, unless it was a typo...you as the surgeon should be billing modifier 54 not 55. Hope that helps!

 

[tnthekids]

We billed 66984-54-LT for the surgery and then on line 2 we billed 66984-55-LT with 7 units for the post op care. My issue is the one day was provided on the same day (because of distance involved). Medicare is denying as not covered for the post op care on line 2. I am trying to find documentation that states if post op care for one day can actually be provided on the same day as surgery and payment would be made.

 

[Cheezum51]

I think your problem is due to the first post op visit being done on the date of surgery. The 90 day global period begins the day after surgery. If you're counting the date of surgery as your first post op date, they're going to reject you billing for 7 units when, in fact, you're only providing 6 units of post op care.

Tom Cheezum, OD, CPC, COPC

 

[tnthekids]

Could you point me to any Medicare documentation or any documentation at all that states if a post op can be done on the same date as the surgery? We are disagreeing at work about whether this would be a payable visit

 

[thomas7331]

Could you point me to any Medicare documentation or any documentation at all that states if a post op can be done on the same date as the surgery? We are disagreeing at work about whether this would be a payable visit

Here's Medicare's publication that addresses this - see pages 7-8:

Global Surgery Booklet

The physician must use the same CPT code for global surgery services billed with modifiers “-54” or “-55.” The same date of service and surgical procedure code should be reported on the bill for the surgical care only and post-operative care only. The date of service is the date the surgical procedure was furnished.

So you should be using the date of the procedure itself as the date of service for your post-operative care charge, but you should not be billing 7 units - one unit of the surgical code with modifier 55 covers all post-operative care, regardless of the number of visits.