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Thread: is this legal?

  1. #1

    Default is this legal?

    AAPC: Back to School
    What if my employer is telling me to code follow up visits 99282's because that's the agreement between the company and the practice, regardless of global periods. I'm not sure that that is legal. Is it? Can I get in trouble for doing that? I know its medicare guidelines, so do I only have to use global periods for medicare charts?

  2. #2
    Join Date
    Apr 2007
    Duluth, Minnesota


    what kind of global issues are you having with ER charges? I mean, typically - a person presents to the ER with an "emergency". what would this emergency visit be conflicting with that it causes a global issue?

    I'm confused.
    Donna, CPC, CPC-H

  3. #3
    Join Date
    Apr 2007
    North Carolina


    CPT's Surgical Package
    According to CPT, the surgical package includes the following:

    The surgical procedure; Local infiltration, metacarpal/ metatarsal/digital block or topical anesthesia;One related evaluation and management (E/M) encounter (including history and physical) that occurs after the decision for surgery has been made and is either on the date immediately prior to the procedure or on the actual date of the procedure;Immediate postoperative care, including dictating operative notes and talking with the family and other physicians;Writing orders;Evaluating the patient in the postanesthesia recovery area;Typical postoperative follow-up care.

    CPT states that "typical postoperative follow-up care" includes only that care which is usually a part of the surgical service. Complications, exacerbations, recurrence, or the presence of other diseases or injuries requiring additional services should be separately reported. This means that, from a CPT perspective, the global surgical period extends from no more than one day before the day of the procedure to as long as is necessary for typical postoperative follow-up care to be completed. In essence, the postoperative period is open-ended.

    Medicare's View
    As is common, Medicare's rules differ slightly from that of CPT. Section 4821 of the Medicare Carriers Manual (available online at cms.hhs.gov/manuals/14_car/3b4820.asp#_1_2) provides a definition of Medicare's global surgical package. Many other payers use this as a model. From a Medicare perspective, surgical procedures include the following services when furnished by the physician who performs the surgery:

    Preoperative visits after the decision is made to operate beginning with the day before the day of surgery for major procedures and the day of surgery for minor procedures;Intraoperative services that are a usual and necessary part of a surgical procedure;All additional medical or surgical services required of the physicianduring the postoperative period of the surgery because of complications not requiring additional trips to the operating room;Follow-up visits during the postoperative period of the surgery that are related to recovery from the surgery;Postsurgical pain management;
    Certain supplies;Miscellaneous services (e.g., dressing changes; local incision care; removal of operative packs; removal of cutaneous sutures and staples, lines, wires, tubes, drains, casts and splints; insertion, irrigation and removal of urinary catheters, routine peripheral intravenous lines, nasogastric and rectal tubes; and changes and removal of tracheostomy tubes).

    Note a couple of distinctions between the Medicare and CPT package: First, unlike CPT, Medicare includes in the surgical package treatment of complications that do not require additional trips to the operating room. Second, unlike CPT, the postoperative part of Medicare's global period is not open-ended. Medicare assigns postoperative global periods of 90 days to major surgeries and either zero or 10 days to minor surgeries and endoscopies. Any services beyond the Medicare postoperative global period, even if related to the procedure, are separately report able. If you have any questions about the length of the postoperative global period assigned to a given code, you can find it in the Medicare Physician Fee Schedule database.

    Now...I'm not sure I understand what you mean by agreement. When you say "company"...is this the hospital, insurance company...(?) Aren't you receiving denials for these services that should be included in the "global package"? Can you expand on an actual patient scenario?

  4. #4


    Yes. I code for the proffesional fees for ER Drs. Pts frequently come into the ER and have minor surgery procesures done like 10061, 12001, ect. Then they will coem back to the ER for bandage changes, more pain meds, and even for no reason, just a "recheck". The Dr just looks at the wound and says its improving and discharges the pt. I don't think These should be billed as 99282. Most of the procedures they are doing have a 10 day global period. I think and bandage changes, suture removals, or "rechecks" should be included and billed as 99024 (post op visit) as long as pts are coming back within the global period. That is how I was trained at previous companies. The billing company I am at now says they have an agreement with the Dr group to bill these visits as a regular E/M levels. Can they have an "agreement" about something that goes against medicare guidlines? I am certified and I dont want to get in any trouble for over coding these visits. I get them everyday. They will add up fast. My follow person says she does get denials sometimes saying the f/u visit is included in the primary procedure. She said she usually just writes the balance off. But what about people who don't have insurance. They are going to get stuck with these bills that were never supposed to be billed out anyway. They dont know the f/u is included. They dont even know what a global period is! I dont think its right. If I am really not supposed to be billing these 99282's I need to stop. I will have to tell my empployer I wont do it if it's not right.

  5. #5
    Join Date
    Apr 2007
    Stratford, NJ

    Default billing 99282s

    ya know what I think?....RED FLAG! RED FLAG! RED FLAG!!!!
    If these visits by your ER docs are w/in the 10-day global pckg of a minor procedure, I can't find any justification to billing an E/M code!! Your billing co, which sounds like maybe an outside billing co for the hospital or Dr's group, cannot decide to have an "agreement" that goes against Medicare policy. I would DEFINITELY bring this up w/maybe your compliance dept, or in the very least, ask your company to show you this "agreement" in writing! Then go to someone or somewhere (CMS??) and find out what you should do in a case like this! I wouldn't risk my certification!

  6. #6


    Why are they going back to the ER for follow up? Why don't they just follow up with their primary care? That would solve your problem! Then you have no 99282's! LOL.

    Anyway.... One thing you cannot do, insured or uninsured, is treat the patients "differently" You can pull any insurance contract and see for yourself. i.e. giving vaccines to only those whose insurances pays the greatest or in your case, billing self pays for global visits. Regardless of their self pay status, the CPT code that was performed, holds a global period. Self pays should be treated the same as if they were insured (with respect to coding/billing - payment arrangements are a different subject) The billing company can only advise what is right and what is wrong - if the physicians send over billing that they know is incorrect - the physicians are held accountable. Now, if the billing company agrees and engages in these practices knowingly, they can be held accountable as well. Medicare policy is Medicare policy. No agreement between third parties can override it. I'm curious as to their rationale behind this? Is this to track productivity? To simply bill and see what happens and who pays? Either way, I disagree with their decision. If I were you, I would politely explain to them they're at risk for fraud/abuse and ask them to reconsider their decision.

    Good luck to you!
    Last edited by ARCPC9491; 02-23-2009 at 09:55 AM.

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