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Tissue expander filling different physician during global

  1. #1
    Unhappy Tissue expander filling different physician during global
    Medical Coding Books
    We have a pt who had insertion of tissue expander 11960 (in head) by another physician, but we are filling the expander (which is bundled into the code).
    We will be performing cranial reconstruction later, but she is still in the global period for 11960. would you bill for these expander fills?

    I told physician we should simply bill the appropriate E&M, and he says the work is worth more than that. What about billing 11960-55? But only bill this once, or each filling?

    Really is appreciated.

  2. #2
    Milwaukee WI
    Default 11960-55
    FIRST - I am assuming your physician and the original surgeon are of TWO different practices (or TWO different specialties within the same practice) ...

    The surgeon who inserted the expanders should be billing 11960-54 and your physician should report 11960-55. You report it only on the first post-operative visit (your payment should be that portion of the global surgical fee that represents post-operative care).

    If you are in the same practice AND same specialty as the surgeon who placed the expanders, then the global period applies to your physician and there is no charge for this service.

    Hope that helps.

    F Tessa Bartels, CPC, CEMC
    Last edited by FTessaBartels; 01-20-2011 at 10:14 AM.

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