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Global Surgery Package and Copays

  1. #1
    Question Global Surgery Package and Copays
    Medical Coding Books
    (please bear with me if you've read this elsewhere--I'm desperate for an answer!)
    I'm a new coder at a busy orthopaedic practice where recently we've had issues with the front end collecting copayments when perhaps they should not have. I was under the impression that in a global period, if the patient had an x-ray, cast, injection, etc., and we bill their insurance company for such, their office visit (99024) would be no charge, but they would still be responsible for a copayment for the x-ray/cast/etc. The check out girls never collect a copayment when they see the 99024 follow-up code, regardless of whether or not an x-ray or cast or other procedure was done. I read the Medicare general surgery guidelines but I'm still fuzzy about this. Could someone please tell me whether a patient is responsible for a copayment in the global period if they have an x-ray/cast/injection in addition to their no-charge follow-up office visit? Also, source information would be GREATLY appreciated! Thanks in advance for any info.

  2. Default Copays in Post-Op Period
    That would depend on the patients' plan. Some probably charge a copay, but others may not. So without knowing what the member is responsible for exactly, I wouldn't collect a copay until the insurance company said what the pt is responsible for.

  3. #3
    I agree with the above, its insurance plan related. What might be helpful for you is that whenever the person that checks for precert calls the carrier, or the person that verifies benefits, could ask that question, that way you will have the answer, can note the chart and collect on the front end.

  4. Question Global Surgery Pkg and co-pay
    Usually the post-op visits are no charge. Since the procedures performed were diagnostic and no office visit accessed,then no co-pay wouldnot apply. Again, it would perhaps be better to verify with the pt.s carrier to best determine, the patients liability.
    ajaj, cpc pending

  5. Smile Patient Account Representative
    This would all depend on the patients insurance carrier. An in-depth insurance verification that suites your type of practice can be a very useful tool. At times some insurances, depending on the benefit package, will quote you copay will cover ov, labs, etc. But, if no ov then patient is subject to deductible and out of pocket. If this is the case, prepping your tickets prior to the visit, will ensure you are aware of what you are to collect at time of service. Visiting with the patients prior to them being seen by the doctor will ensure there are no surprises for the patient at time of collection. In my experience, this improves the practice-patient relationship, because the patients feel we are looking out for their best interest and staying proactive not only in their medical care, but also their financial care. This ensures patients are not incurring balances they are not aware of. Hope this helps!! If you need more information on in-depth insurance verifications just let me know.

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