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Surgical package

  1. #1
    Default Surgical package
    Medical Coding Books
    I work for orthopedic surgeons who send patients to pcp for pre-surgical clearance. Our problem is one pcp in area is refusing to see our patient(which are some of pcp's own patients) unless we give inteneded surgical codes. According to this pcp they were told by a consultant that now that consult codes are no longer ok to use that the pcp is entitled to part of surgeons surgical package. Is their another surgeons' office having this trouble? Anyone ever heard of pcp doing this? Any advice will be welcome.

  2. #2
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    Columbia, MO
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    If you are requesting the PCP perform the preoperative encounter then they are doing the preoperative management of your surgical service at your request so yes they need your surgery code so that they can bill the pre op portion of your global with the 56 modifer and your surgeon will have that amount (approx 10%) deducted from their reimbursement.

    Debra A. Mitchell, MSPH, CPC-H

  3. #3
    Default
    regarding Mitchellde's comment...what if you are only sending the pt to the pcp for medical clearance? The surgeon's office is taking care of bloodwork/EKG ect..?

  4. #4
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    Columbia, MO
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    The 56 modifier applied to the surgical code is for the preop mgt, the blood work and EKG can still be charged.

    Debra A. Mitchell, MSPH, CPC-H

  5. #5
    Lightbulb
    That's wild, I did not realize that you could bill like that. We do pre-op physicals at our family practice group. Am I understanding correctly that you could bill the office encounter and a surgical code with mod 56 appended and get paid for both, or would you only bill for the surgical code with mod 56?
    Jason Steeprow, CPC

  6. #6
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    Columbia, MO
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    the surgical code with the 56 is in place of the ov code.

    Debra A. Mitchell, MSPH, CPC-H

  7. #7
    Cool surgical package
    How or what did Pcp office bill before Medicare stopped consult codes. It seems this was never an issue before Jan 2010.Cpc:

  8. #8
    Cool surgical package
    How or what did Pcp office bill before Medicare stopped consult codes. It seems this was never an issue before Jan 2010.Cpc:

  9. #9
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    Columbia, MO
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    To be honest a preop encounter was not to be billed as a consult and this was one of the reasons CMS decided to discontinue consultations. The surgeon is not requesting a consult from the PCP they are requesting a medical evaluation. The AMA created the global modifiers years ago as a way to split the surgical global into three distinc parts. If the suregeon requests the preop to be performed by another physician then he is transfering that part of the global to that physician. If the surgeon wishes to perform part of the preop then the PCP can bill using the 56 and the 52.

    Debra A. Mitchell, MSPH, CPC-H

  10. #10
    Default
    Mitchellde, do you (or anyone else in this post) have a source document for this info? It's very probable I will need to cite something official when I explain this to the specialist offices to get the proper sx codes .

    This is a very interesting twist to coding pre-op, but I suppose it makes good clean sense.
    Jason Steeprow, CPC

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