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Question When to report 99024

tatumroe

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I understand that any visit within the post op period related to the procedure should be reported with a 99024. My question is who reports the 99024? Only the provider/practice who performed and received reimbursement for the procedure? I have a primary care provider who often sees his patients after they have had a surgery in the hospital (not performed by him or any of our providers) and he is reporting a 99024. Should he be or should he be reporting a regular E&M visit even if he addresses the reason the patient had the surgery since we were not the ones who performed nor were we the ones who were paid for the procedure. Or does everyone, regardless of specialty, report the 99024 during the post op if they see the patient during the post op period?
 
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If the provider in your group is seeing the patient for medical management after surgery, this is not reported with 99024. Typically, the primary care physician or other qualified health care professional is providing care for the patient's medical conditions (e.g., diabetes, hypertension) during the post-operative stay and reports hospital E/M services. Rarely, the provider is assuming all post-operative care at the request of the surgeon and reports with the surgical code and modifier 55 and this hand-off usually occurs after the patient is discharged. It would be a shame for your practice to lose the revenue this provider is earning by report 99024.
Cindy
 

tatumroe

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We are seeing the patient in the office (outpatient) and he was seeing this patient for a follow up after surgery, fatigue and a refill. So you would agree that we would not report the 99024, but in fact, a regular E&M code since he was not the performing provider of the procedure?
 

csperoni

True Blue
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Yes, E&M should be billed by a primary care physician who is treating medical problems that just happen to be occurring during the postop period of a surgery. No modifier is needed as your physician is not the surgeon nor part of the surgeon's group.

If the situation is (this does sometimes happen mostly in rural areas where doctors are not plentiful) that the surgeon does the surgery, and then transfers the care to another physician, then the surgeon should be billing the surgery with -54 and the physician doing postop care bills the same surgery code with -55. It does not seem to be the case here, but I want to cover all bases.

I have some concern about the wording "seeing this patient for a follow up after surgery, fatigue and refill." What type of follow up after surgery? Did the patient not follow up with the surgeon? Why did this patient need follow up after surgery by your physician? I'm thinking it's likely just poorly worded, leading to the possible confusion. The patient is likely actually following up on hypertension or diabetes or arthritis, etc.

Here is the full CMS global surgery booklet referenced above by Dorinda. https://www.cms.gov/outreach-and-ed...oducts/downloads/globallsurgery-icn907166.pdf
It specifies, among other things "The global surgical package, also called global surgery, includes all the necessary services normally furnished by a surgeon before, during, and after a procedure. Medicare payment for a surgical procedure includes the pre-operative, intra-operative, and post-operative services routinely performed by the surgeon or by members of the same group with the same specialty. Physicians in the same group practice who are in the same specialty must bill and be paid as though they were a single physician."
Since your physician is not the surgeon/surgeon's group, the global surgical package does not apply (unless transfer of care, see page 8).
 
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