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different specialties same group practice

  1. #1
    Default different specialties same group practice
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    We have a group of 2 pulmonologists who are considering adding a thoracic surgeon to the practice. Currently, when there are pulmonary complications (such as pneumonia, emphysema, bronchospasm) from his thoracic surgeries he refers patients (or requests consults) to the pulmonology group. As far as I know, there have been no problems for the pulmonology group billing for their services within the global period of the surgery. If the thoracic surgeon becomes part of the same group practice as the pulmonologists, will this cause a problem when billing the post-op complication visits for the pulmonologists?

    Any information I can get would be extremely helpful.

    Thank you!
    Shena Betts, CPC
    Physician's Professional Mgmt

  2. #2
    Default Post op complication management
    Any provider can bill for post op complications using -24 modifier on the E&M service with the complication diagnosis codes. You can also modify procedures the pulmonologists may do during the post op period, again using the diagnosis codes for the complication.

    Good luck.
    Pam Vanderbilt, CPC, CPMA, CPPM, CPC-I, CEMC, CEMA

  3. #3

    Our Medicare manual says the global surgical package includes: complications following surgery, includes all additional medical or surgical services required of the surgeon during the post-op period of the surgery due to complications that DO NOT require additional trips to the operating room.

    So if the follow-up visit for the complication does not require a return trip to the OR, wouldn't it be included in the global package? I'm confused due to the complication being managed by the pulmonologist not the surgeon. However, they would be in the same group billing with the same group number so would the pulmonologist's services be included as well?

    thank you,

  4. #4
    Default thoracic and pulmonary
    I work for two practices in the same space. One is Pulmonary and the other Thoracic. Many of our patients are referred from Pulmonary to Thoracic and vice versa. They frequently see the same patient in the hospital as well. Even though the share the same group number they are still two different specialties. We have not had a problem with billing as far as I know. Often the Thoracic surgeons do more extensive procedures than pulmonary but alot of our patients will see both physicians. Our pulmonary docs deal with COPD, asthma, interstitial lung disease, pneumonia and additional respiratory issues whereas our thoracic surgeons lean more toward pleural effusions, lung biopsies, lung resections, lobectomies, etc. hope that info helps.


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