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e/m & taking over care

  1. #1
    Cool e/m & taking over care
    Medical Coding Books
    a couple of our surgeons (spine surgeons) is taking over care of patients from an orthopedic surgeon who is retiring. If the ortho. phy. performed a surgery and one of our surgeons assisted, the patient comes in for continued care due to the ortho. surgeon is retiring before the 90 day global period, would the be considered an established patient. I'm thinking yes.

    Also, if the ortho surgeon performed a procedure w/90 day global without the assistance of one of our spine surgeon and the ortho. surgeon transfers care to one of our physicans, would this be charged as a new patient or consult. NOT SURE!!

    Thanks for any help!

  2. #2

    If doing f/up care during the global/post op period, how about use of modifiers:
    -54, Surgical Care Only (on the surgical codes)
    -55, Post Op Care Only
    -56, Pre Op Care Only

    Thereby breaking down the Global Package into components that each of the surgeons bills for separately.

    Just a thought...hope it helps.
    Sylvia Thompson, CPC
    Billing Supervisor
    San Diego, CA

  3. Default
    couple of scenarios here:

    If spine surgeon assisted the ortho surgeon, he is eligible to report the surgical procedure with "Assistance at surgery modifier".

    If he is also taking care of postop; on the DOS of surgery he should also report the surgery code with 55 modifier. And remaining of the patient's postop visits (dates of service) to this spine surgeon's clinic should be reported with 99024.

    The ortho should report the surgery on the dos of the surgery with 54,56 modifiers. If he performed any E/M on the same DOS or one day before which led to surgery; he can also report that E/M with 57 modifier.

    Hope that helps!
    Last edited by Jagadish; 12-01-2007 at 05:20 AM.
    Jagadish, CCS-P, CPC

  4. #4
    Default e/m taking over care
    Thanks for your responses however I have another question. If our spine surgeons inherits (if you will) patients from the ortho surgeon. Would it be more appropriate to charge a new patient visit or consult. I'm thinking a new patient visit since the the orto surgeon is retiring.

    Thanks again!

  5. Default
    A patient is new, if they've never been face-to-face with any of the providers in your group. That includes surgeries. So, these patients that your surgeons assisted during surgery with are not new patients. Also, because of the surgical assist, just use the postop code 99024 for internal tracking until the 90 day global period ends.

    In response to the second question, a consult is only supported if the provider sending the patient to the specialist wants advice and opinion on how to treat the patient.

    For consults, your surgeon would see the patient and send advice and opinion back to the referring provider.

    These patient's are simply coming into the practice because they need care. Even though the retiring surgeon is 'referring' them to your surgeons, his 'referral' is really only a suggestion and the patient's are free to seek services anywhere and not just with your surgeons. If none of your surgeons have ever seen the patient before, they may be billed as new patients. If any of your surgeons ever assisted at surgery on the patient, then they'll be established.

    Hope this helps,


  6. #6
    Default e/m taking over care
    Thanks KRIS!!!

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