Wiki Single surgeon performing both neurosurgery and neurovascular intervention

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valelim

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If a surgeon acts as both neurosurgeon and neurovascular surgeon:

Neurovascular performs coiling of SAH-zero day global

Same Neurosurgeon performs craniotomy to evacuate the hematoma-90 day global

Are all subsequent visits part of the global period? My thought is, yes, however, my surgeon is questioning this. Her rationale is, if the coiling was done by a neurovascular surgeon and, craniotomy done by different neurosurgeon, subsequent visits would be billable for the neurovascular surgeon. As she is acting as both, she's questioning whether or not she can bill for subsequent visits. The diagnosis code is the same for both surgeries. Taxonomy code is the same for both specialties. Any thoughts are appreciated!
 
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Were both procedures done during the same case? Would the patient be following up with the neurovascular surgeon for that and not the neurosurgeon if they had been two different providers?
Think of it this way, how will it be justified that a 24 is being appended to the E/M being billed for the follow ups for a patient in global with that provider? The major procedure global takes precedence. The patient is in a global for the 90 days. How will it be explained to the patient that they had a major (90 day) surgery yet now they are having to pay co-pays or co-insurance for all the follow ups because one or more of the additional procedures was 10 day? What is being done at the office visit during the global? Why would the provider want to do that? It just feels bad on top of everything else. They got paid for the major procedure 90 day.

40 - Surgeons and Global Surgery
"Modifier “-24” or “-FT” is intended for use with services that are absolutely unrelated to the surgery. It is not to be used for the medical management of a patient by the surgeon following surgery."

Modifier 24 Fact Sheet

www.novitas-solutions.com www.novitas-solutions.com

"Inappropriate use: The medical record documentation clearly indicates the E/M is related to the surgery." "Reporting exams performed for routine postoperative care."​

Additionally, there is only one, primary taxonomy assigned to a provider and single NPI for an individual.
 
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We have 2 neurovascular providers and we bill it as 99024. Even if the craniotomy was done by a different neurosurgeon, subsequent visits would not be billable for the neurovascular surgeon since their taxonomies are the same (sub-specialties are considered the same primary taxonomy).
 
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