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Surgical global when done out of state

  1. #1
    Question Surgical global when done out of state
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    Hope someone can give me some guidance regarding surgical global period.

    We have a patient whom had partial hip replacement done due to injury while out of state.She is now coming to our Orthopedic clinic for followup visits.

    Must we code these visits as "global- 99024" or can we charge for E&M office visits?

    I understand global periods are global periods in that whether a patient has insurance or not we must treat all the same in regards to global period w/no charges, BUT if our hospital,taxID# or NPI not billed for prior surgical procedure done out of state MUST we still consider the followups' being done as global non-billable except for x-rays,etc?

    Thanks in advance to all whom reply!

  2. Default
    look at modifiers 54 surgical care only and modifier 55 post op management only.

  3. #3
    You can bill visit to visit if your doc's did not perform the surgery. You can use the 54/55 modifier but you must be sure that the doc who did the sx billed with a 54 or your claim will be denied with the 55 modifier.

  4. #4
    Again, thanks to both of you for responding. I assumed since our physicians/facility will not be compensated for actual surgical charges we should not be forced to provide free 90 day global followup care.But I am also aware that regardless whether a patient has insurance or is self pay we must still treat both w/90 global followup care, so I just wasn't sure how global policy applied in our case.

    Unfortunately this patient was treated at a hospital out of state & we have no way of knowing whom performed partial hip replacement nor how their billing dept. billed the charges out. Hopefully they applied mod. 54 as noted in the second reply to my question, since they should have been aware based on patients' demos she lived out of state & would obviously seek followup care closer to home. I guess we 'll take our chances billing out E&M new patient office visit charge & see what happens.

    Thanks again to all whom took the time to respond-this site is a great asset to AAPC members to utilize! I have never been disappointed when submitting a question and have total faith in all your replies!

  5. #5
    Greeley, Colorado
    Exclamation Medicare patient?
    If this is a Medicare patient you will need to enter the date of surgery and the date the patient care was released by the surgeon (can't remember what location on the claim form that goes on). I would do some investigation into where the surgery was done. Medicare might even tell you who did it, if you get the right rep .
    Lisa Bledsoe, CPC, CPMA

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