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Surgical Post Op E/M

tboback

Networker
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42
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For auditing purposes I need help with this:

Scenario ONE (Doctor A surgeon/Doctor B same practice MD/DO)
Day 1 - Patient has surgery on spine by doctor A
Day 10 - Pt has E/M with doctor A (included within surgical package)
Day 28 - Pt has E/M with doctor B for refill on Rx
Is day 28 payable?

Scenario TWO (Doctor A surgeon/Doctor B different practice/specialty MD/DO)
Day 1 – Patient has surgery on spine by doctor A
Day 10 – Patient cancels E/M with doctor A because of transportation issues and reschedules for later date.
Day 12 – Patient has E/M with doctor B (different practice/specialty). Doctor B removes staples and refills Rx (Payable? Or included within surgical package?)
Day 20 – Patient has E/M with doctor A for surgical follow-up (Payable?)

Scenario THREE (Doctor A surgeon/Doctor B same practice MD/DO)
Day 1 - Patient has surgery on spine by doctor A
Day 10 - Pt has E/M with doctor A (included within surgical package)
Day 28 - Pt has E/M with doctor B for refill on Rx
Day 45 – Pt has E/M with doctor A for refill on Rx
Day 65 – Pt has E/M with doctor B for refill on Rx
Day 85 – Pt has E/M with doctor A for refill on Rx
Are days 28, 45, 65, 85 E/M days payable?

NEED YOUR HELP
 

tboback

Networker
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42
Best answers
0
Scenario ONE
Doctor A Neuro Surgeon
Doctor B Spine Surgeon

Scenario TWO
Doctor A Spine Surgeon
Doctor B Pain Management

Scenario THREE
Doctor A Orthopedic Surgeon
Doctor B Internal Med
 
Messages
4,466
Location
Milwaukee WI
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Global

The global surgical package applies to the surgeon who performed the surgery - AND - to any other physician in the same practice and same specialty. This refers to recognized specialties. I do not know if "neuro" and "spine" are recognized as two different specialties.

Any other physicians who might treat the patient during the global period are not covered under the global surgical package.

Hope that helps.

F Tessa Bartels, CPC, CEMC
 
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