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visits included in breast reduction global period

  1. Default visits included in breast reduction global period
    Medical Coding Books
    Does anyone know how I can find out what visits are included in the global period for breast reduction surgery? If the global period is 90 days, and the patient comes in after 6 months for a re-check, will that get paid as an office visit or is that considered included in the surgery package? Is there any specific diagnosis code i should include with the 6 month re-check office visit?


  2. #2
    Milwaukee WI
    Default 90 day global
    The breast reduction surgery carries a 90-day global period ... BUT

    Our Plastic Surgery Department has an policy in place for all cosmetic procedures (i.e. known in advance not covered by insurance and paid in advance by patient) extending the "global" period to 1 year. Because the full results of many of these procedures are not known within 90 days, our surgeons feel this is a more accurate reflection of the true requirements for follow-up for these surgeries.

    Again ... this policy applies ONLY to truly cosmetic surgeries, where there is no bill to or payment from insurance company, and the patient is responsible to pay in full in advance of surgery.

    F Tessa Bartels, CPC, CEMC

  3. Default

    I'll check with the physician and see if he has a similar philosophy on cosmetic procedures. We also have quite a few breast reductions done for medical reasons (611.1, 723.9, 723.1 etc). Do you think an office visit for re check of breast reduction for medical reasons would be covered at 6 months?

  4. #4
    Milwaukee WI
    Default You ask
    You ask: Do you think an office visit for re check of breast reduction for medical reasons would be covered at 6 months?

    I don't know. I suppose it would depend on diagnosis and whether this is a covered item for the patient's plan. It is outside the global period. If insurance denies be sure you have an ABN that the patient is responsible.

    F Tessa Bartels, CPC, CEMC

  5. Default
    Yes you will get paid for a 6 month follow up visit on a breast reduction. You can use a V67.XX code. Coding Edge May 2009 issue had a nice article on billing for aftercare and followups.

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