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E/M Question

  1. #1
    Default E/M Question
    Medical Coding Books
    Patient had shoulder surgery 10 days ago by his orthopedic Dr.
    My Dr. was covering for this Dr. while he was out of town and had to see
    this patient for a complication from surgery.

    What do i bill for this office visit?

    Thank you!!!

  2. Default

    If the Ortho Surgeon passed all the post-op care to your physician, then code the the surgical CPT with mod -55. Which means the ortho surgeon must code his surgery CPT with mod -54 and -56

    If your physician (same specialty/same group) was only covering "in place" for the surgeon for a 3-day weekend, then your physician codes as that surgeon would. So unless the complication required a return to the OR, then for MCare the OV is a global service. For non-mcare payers, the CPT global rules allow for an OV with mod -24 with a DX to identify the complication

    If your physician (different specialty or group) was covering for the surgeon for a 3-day weekend, then he is not bound by the surgeon's global period and can code the OV as he usually would as a New or Est patient.

  3. #3
    Thanks a million!!!!!! I appreciate your time!

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