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E&M during Global Surgery

  1. #1
    Default E&M during Global Surgery
    Medical Coding Books
    We are having an office debate about this situation.

    Dr. Cardiologist sees a hospital patient, does an in-patient cath and determines patient needs bypass surgery. Dr CVSurgeon does surgery. Dr. Cardiologist does all follow-up inpatient care, i.e. 99232. Both Dr. Cardiologist and Dr. CVSurgeon are in practices that are owned by a parent group and bill under the same tax ID.

    Questions - Is it appropriate for Dr. Cardiologist to bill the follow-care during the global period? Where is the line drawn -global package versus medically necessary care? Is management of medicines, etc (anything other than wound check) enough?

    Any thoughts, documentation sources, etc., will be greatly appreciated.

  2. #2
    Milwaukee WI
    Default Two different specialties
    Assuming the Cardiologist and the CV Surgeon have different specialties (would be the case in our practice), the Cardiologist is not affected by the global period for the surgery performed by a different specialist.

    F Tessa Bartels, CPC, CEMC

  3. Default
    I agree with Tessa's post. You can look at it this way, the CV surgeon's post-op visits are included in the payment he/she will receive for the surgery, the cardiologist does not get any of this payment so he/she should be able to bill for these services.

    Of course medical necessity is the overriding factor. Is it really necessary that the cardiologist see the patient post-operatively? My surgeons have told me it is. They have told me its been years since they've managed a patient's meds (for example) so it is necessary for the cardiologists to f/u on other cardiac conditions and adjust meds accordingly.

    If the cardiologist is only following up on the surgical condition, then I would question the medical necessity of those visits.

    Lisi, CPC

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