Wiki Surgeon billing a discharge summary?

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TracyAlder

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A friend of mine works for a vascular surgery practice and one of the surgeons she works for keeps trying to bill 99234-99236 when he discharges a patient he operated on. She tries to explain to him why he can't do that because of the global period but he says that he can because, well, the codes are right there in the CPT book.

She and I both know that he cannot do this but neither one of us can find CMS documentation that backs that up other than the general guideline that the global period includes the discharge summary.

Can anyone help with this one? Thank you!
 
So if a patient gets seen in the office a week after discharge, and the global is 30 days, does he bill for that as well?? You can tell him that the discharge day management is there for the hospitalist who does the discharge, or the rehab doctor who does the discharge from inpatient rehab.
 
Amazingly enough, he doesn't try to bill for the post op! I'll tell her to try what you suggested, though. Thank you!
 
One of the best references for the guidelines on the global period is the CMS manual, linked below. On page six, it lists the services that are included and excluded from the global period. As noted there, "follow-up visits during the post-operative period of the surgery that are related to recovery from the surgery" are included in the global package, and this would include a discharge-day evaluation and management service by the physician after surgery.

Discharge services are not limited just to hospitalists, but could be used by the surgeon if they were acting as the attending physician and the service was outside of the global period or was for evaluation or treatment of a problem unrelated to the procedure. I'd also just add, though, that for routine outpatient surgeries the patient is not usually admitted to an observation status, so the 99234-99236 code range for observation E/M is likely incorrect in any case. You would only report a 'discharge' when the patient has actually been admitted.

 
That's wonderful, Thomas! Thank you for finding that. I think hearing something directly CMS will sink in!
 
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