Surgery done in California and Post Op Care done in NJ

Diana2032

Networker
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Succasunna, New Jersey
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Good evening,

Our pt lives in NJ and went to California on business. While there he injured his knee and had sx done on 3/14/16. The procedure performed in California carries a 90 global period. The pt came back to NJ and made an appointment to see the Orthopedic surgeon I do billing for on 4/11/16. Do I bill this as a new pt visit? Does this scenario fall under a tranfer of care category? Do I need to request a transfer of care request from the surgeon in California? The pt is still under the global period. Please advise.

Thanks,
 

CodingKing

True Blue
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I would follow up with the physician that did the surgery to make sure they report the modifier for surgical care only so you can bill with the modifier for Post Op Only Aldo be sure its documented that patient was to follow up in their home state, Then your provider can bill the procedure with the post op only modifier.
 

Siva03

Contributor
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First we need to check how this was billed by the surgeon in california , was this billed globally including post op care or originally only surgical care alone was billed , based on that info only we could proceed
 

CodingKing

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Hi,

The surgeon in California billed globally. How should I bill for my doctor?

Thank you so much!!

You will need to contact the office in California to work it out as they inappropriately billed as global. Maybe they weren't aware at the time of billing that patient was going to follow up with his physician at home?
 

KMCFADYEN

Expert
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Roanoke, VA
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Yes, you will need to contact the physician to have them send an adjustment appeal to insurance as they should have billed the surgery code with modifier 56 for preoperative management only.
Once that is done, you would bill the same surgery code with modifier 55.
I believe this gets you about 17% of the fee for the code.
There are specific rules as to how you bill this.
 
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