transfer of care for global period
you can find this at MCM (medicare carrier manual) subsection 4822.A.2 and states (i have pasted it directly from the manual) :
"Services of other physicians except where the surgeon and the other physician(s) agree on the transfer of care. This agreement may be in the form of a letter or an annotation in the discharge summary, hospital record, or ASC record;
*III. Billing Requirements for Global Surgeries
To ensure the proper identification of services that are, or are not, included in the global package, the following procedures apply.
*A. Procedure Codes and Modifiers
Use of the modifiers in this section apply to both major procedures with a 90-day postoperative
period and minor procedures with a 10-day postoperative period (and/or a zero day postoperative period in the case of modifiers “-22� and “-25�).
*1. Physicians Who Furnish the Entire Global Surgical Package
Physicians who perform the surgery and furnish all of the usual pre-and postoperative work bill for the global package by entering the appropriate CPT code for the surgical procedure only.
Billing is not allowed for visits or other services that are included in the global package.
*2. Physicians in Group Practice
When different physicians in a group practice participate in the care of the patient, the group bills for the entire global package if the physicians reassign benefits to the group. The physician who performs the surgery is shown as the performing physician. (For dates of service prior to January 1, 1994, however, where a new physician furnishes the entire postoperative care, the
group billed for the surgical care and the postoperative care as separate line items with the appropriate modifiers.)
*3. Physicians Who Furnish Part of a Global Surgical Package
Where physicians agree on the transfer of care during the global period, the following modifiersare used:
• “-54â€� for surgical care only; or
• “-55â€� for postoperative management only.
Both the bill for the surgical care only and the bill for the postoperative care only, will contain the same date of service and the same surgical procedure code, with the services distinguished by the use of the appropriate modifier.
Providers need not specify on the claim that care has been transferred. However, the date on which care was relinquished or assumed, as applicable, must be shown on the claim. This should be indicated in the remarks field/free text segment on the claim form/format. Both the surgeon
and the physician providing the postoperative care must keep a copy of the written transfer agreement in the beneficiary's medical record.
EXCEPTIONS:
• Where a transfer of care does not occur, occasional post-discharge services of a physician other than the surgeon are reported by the appropriate evaluation and management code. No modifiers are necessary on the claim.
• If the transfer of care occurs immediately after surgery, the physician other than the surgeon who provides the in-hospital postoperative care bills using subsequent hospital
care codes for the inpatient hospital care and the surgical code with the “-55� modifier for the post-discharge care. The surgeon bills the surgery code with the “-54� modifier.
• Physicians who provide follow-up services for minor procedures performed in emergency departments bill the appropriate level of office visit code. The physician who performs the emergency room service bills for the surgical procedure without a modifier.
• If the services of a physician other than the surgeon are required during a postoperative period for an underlying condition or medical complication, the other physician reports
the appropriate evaluation and management code. No modifiers are necessary on the claim. An example is a cardiologist who manages underlying cardiovascular conditions of a patient.
