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E&M following global surgery

  1. #1
    Default E&M following 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
    If it wasn't for the global period it would be appropriate to bill for Dr. Cardioloigist and Dr. CTS since they are different sub-specialties. However if Dr. Cardiologist is infact seeing the pt for follow up care with the same diagnosis as prior to the surgery it will be global. We are interventional cardiolgists and even when a CTS from another practice performs the CABG we can not get paid for seeing the patient because it is diagnosis driven. If the visit was for anything unrelated you could bill with the appropriate modifier. In my experience it just is not possible to get paid for the follow-up care.
    C. Weaver, CPC, CCC

  3. #3
    Actually now that I think about it more, I wonder if you can bill the visits but with modifier -55 for postop management only??? The patient usually schedules the f/u with us and not the the CTS, so I can see where this might work.

    Something to think about????
    C. Weaver, CPC, CCC

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