I apologize. I know this is long.. but it's a complicated problem.. at least to me it is.

Here's the scenario. Dr. X (our doctor) was asked to cover for Dr. Y while he was away on vacation. They are the same specialty (ortho) but are NOT in the same group and therefore do not bill under the same Tax ID, etc. The verbal agreement is for coverage with no mention of billing stipulations, etc.

Before he left, Dr. Y had seen a patient who had been in a car accident. The patient was admitted and was diagnosed with several rib fractures and some other contusions.. all of which were being treated conservatively at that time. Of course, Dr. Y's office had billed for conservative treatment of these fractures, etc., and therefore the patient was under a "global period" as such. Then, while Dr. Y was away, Dr. X (our doctor) was called to see the patient due to worsening symptoms.

Dr. X (our doctor) ordered more xrays and discovered a previously undiagnosed fracture which would require surgery. Dr. X splinted the fracture for the time being and then informed Dr. Y of this new finding via the telephone. Dr. Y stated he'd take the patient to surgery for treatment the next day (when he was returning from vacation.) Dr. X informed the patient and the family of this conversation.

Two days later, Dr. Y called Dr. X (our doctor) and asked him to accept a "transfer of care" for the patient. Dr. Y explained that the patient was not happy and had "fired him" because he didn't take care of her fracture on the day he said he would. (At this point, the patient still hadn't gone to surgery).

Now here are my questions.

1. Can we charge for our doctor's initial visit (E/M with a -25 modifer plus conservative treatment of the FX w/out manipulation?) even though he was covering for another doctor and the patient was under a global period for charges stemming from OTHER fracture care?

2. If so, do we charge as an established patient or a new patient? Do we need to add a -24 to signify the other doctor's global period since we were acting in his place at the time?

3. For the surgery of the new fracture etc, what modifiers will be necessary because of this situation?

Any help would be appreciated.