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Medicare 3-day global

  1. Default Medicare 3-day global
    Medical Coding Books
    Does Medicare 3-day global period apply to different doctors in the same clinic? A Pt saw the nurse practitioner in the office, then was admitted the next day where one of our doctors made rounds. Do I need to delete the OV and just charge the rounds?

  2. #2
    Louisville, KY
    I'm not aware of the Medicare 3 day window impacting professional fee coding, only facility charges. According to everything I've read, the impact is only on the IPPS side. Pro fees are not part of IPPS normally.
    Last edited by kevbshields; 02-05-2012 at 09:33 AM.

  3. #3
    Columbia, MO
    Here is what I have on the revised 3 day rule as it will impact some physicians starting July 1:
    New modifier-PD -Diagnostic or related non-diagnostic item or service provided in a wholly owned or operated entity to a patient who is admitted as an inpatient within 3 days—changes to Medicare 72 hour rule go in to effect July 1st, 2012.
    CMS is expanding the “three-day payment window” for outpatient services provided within 72 hours of an inpatient admission. As of July 1, 2012 the payment window will apply to both diagnostic and non-diagnostic services.
    Medicare will pay a reduced fee for physicians’ services that are clinically related to an inpatient admission, occur within 72 hours of the admission, and are furnished by a physician practice wholly owned or wholly operated by a hospital. The rule applies whether the inpatient and outpatient diagnoses codes are the same or different.
    Claims provided by any physician practice owned or controlled by a hospital will have to be held for at least three days prior to submission: The practice does not want to submit a claim without modifier PD, and then discover that the patient was admitted within 72 hours. The hospital is responsible to notify the practice of related inpatient admissions.

    Debra A. Mitchell, MSPH, CPC-H

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