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Thread: Global or Decision for surgery

  1. #1
    Join Date
    Apr 2007

    Default Global or Decision for surgery

    AAPC: Back to School
    patient of Dr. O had excisional biopsy of a skin lesion on the left chest wall on 1/20/2011.

    Today (1/26/2011) Dr. W saw the patient for suture removal (Not a true transfer of care to another provider since we are under the same tax ID). However, Dr.W did review the history of the lesion, revise the lesion/biopsy site and remove the stitches.

    Her biopsy results showed a malignant lesion with invasion of the borders and depth. I decided that this will require surgery by another provider. So, pt was referred to a surgeon.

    How do I bill that?

    My thoughts: We are still in the global window period for the excisional biopsy which includes the suture removal. There was no true transfer of care from Dr. O to Dr.w (same tax ID). Dr. W did E&M part by getting the history and revision/exam. Removed the sutures but also reviewed with her that she had a malignant lesion and the margins were not clear. However, he did not perform another excisional biopsy to clear the margins. he made the decision for surgery but referred her to a surgeon.

    To me this is a 99212 -57, 99024
    please you info will be really appreciate
    Thank you.

  2. #2
    Join Date
    Apr 2007
    Milwaukee WI

    Default NOT decision for surgery

    The decision for surgery modifier is appropriate ONLY for the surgeon who will be performing the surgery. Since your physician is NOT performing additional surgery, but referring the patient to another surgeon, this entire visit probably falls under the global period of the original surgery. I would code only CPT 99024.

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

  3. #3
    Join Date
    Apr 2007

    Default global or desicion for surgery

    Thank you!

    I have one more question.

    so it will be the 99024. if Dr. O was the one proforming the surgery, but Dr. O removed the suture and made the decision that futher surgery was need it?

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