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Post-op status from another physician

  1. #1
    Default Post-op status from another physician
    Medical Coding Books
    When a pcp sees a patient who is being followed by another physician for a surgery, does it count towards MDM if there are no problems? Here's the example:

    The pt comes in for depression with status post exostectomy of right great toe. The documentation regarding the toe is:

    History: He states that he is still seeing Dr. Seuss for his right great toe and his toe has been giving him no issues.

    Exam: Right great toe with full range of motion. Nontender, no erythema.

    A/P: Exostectomy of the right great toe. To continue to follow with Dr. Seuss.

    This patient is still in the global period with the other doc so should the PCP get credit for this review or should it be carved out of the visit? A level 4 was billed and if I carve out the toe (no pun intended!), the most that's supported is a 99213. What does everyone think??

  2. #2
    It sounds like the depression was the primary reason for this visit, if the primary reason is for something other then the post op. I would bill for this services. Also since the physician also looked at the toe, I would use this as a secondary dx.

  3. #3
    Kingsport, TN
    I agree. Also, I would use a 24 modifier for the e/m.

  4. #4
    On the E/M, you should use the 55 modifier, when one physician performs the postop management and the other has performed the surgery

  5. #5
    Kingsport, TN
    After looking at this closer, I don't think a modifier is even needed. If the depression was the reason for the visit with the pcp, he should be able to bill without modifier for post-op care because he really is not providing that service. As stated, another physician is following the post op care. Sorry.

  6. #6
    Why couldn't you just code the depression, 311 and the v45.89, postop status, to indicate that the surgery was addressed. Did the provider give a new Rx for the depression, is that why a level 4 was coded?

  7. #7
    She did change the Rx but since it was only an established problem that was worsening, the MDM for the depression itself would be low complexity, which wouldn't support a level 4. This is why the toe issue is so important. Do I give her credit for it even though it's being managed by the specialist and rightfully so? If the pt had complained about the toe then I definitely would. Since he didn't have any complaints about it, I'm not sure why it was even addressed when she knew he was being followed elsewhere for it. It feels like we're charging for a service that was already paid to another doctor, especially since there wasn't any problem. Or, am I being too nit-picky??
    Last edited by SUEV; 03-04-2009 at 05:09 AM.

  8. #8
    I don't think you are being to picky at all. It sounds like the visit warrants a level 3, instead of a 4. Did the provider determine the toe surgery to be the cause of the depression? If not, then I would only code the s/p surgery code as an additional diagnosis.
    I know every facility is different, but we determine our E&M based on MDM. If the other 2 components are a level 4 and the MDM is a 3 we will code the 3 to support medical neccisity.

  9. Default
    I agree w/Maysons, level 3 seems appropriate; your physican was adding way too much starch to their gravy for no apparent reason, once the patient indicated there was no problem with the toe, it should have stopped there.

    Also, I agree with KMHALL, no modifier is indicated, especially modifier 55! This visit has nothing to do with the surgery, this physician has nothing to do with his post-op care, it's about their depression and it's management. Of note, modifier 24 is to be utilized only when a patient is seen by the same physician who performed the surgery during P/O global for a separate issue, not for every other physician they happen to see during a global period for care that is unrelated to that surgery.

    ENT CT

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