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Billing after kidney transplants

  1. #1
    Default Billing after kidney transplants
    Clearnace Sale
    1. After a kidney transplant, can the urologist bill for immunosuppression during the global period since technically this is what the patient is now being treated for versus renal failure?

    2. If the patient rejects the kidney during the global period, can the urologist bill for the services (E/M, procedures etc.) or is this considered a complication of surgery?

    Thank you for any help I can recieve. I am new to this area.

  2. #2
    Milwaukee WI
    Default Medicare
    Scenario # 1 is global no matter how you try to phrase it. It is directly related to the surgery performed and is therefore postoperative care.

    Scenario # 2 ... Medicare will not pay for any services in the postoperative period unless they require a trip to the OR. Complications are considered part of postoperative global package per Medicare.

    Commercial insurance MIGHT consider you scenario # 2 as a legitimate separately reportable E/M service. (But I'm guessing all your transplant patients were on dialysis and therefore covered by Medicare.)

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

  3. #3
    Thank you Tessa for the input. Would you mind if I contacted you for further questions? My email is if you would like to email me your information.

    Melody James, LPN
    Compliance Auditor
    Surgical Specialist of Oklahoma, pllc

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