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Co-management question

Gail Posted Wed 04th of December, 2013 17:02:12 PM

My question is if a patient should be charged 2 copays, 1 from the Surgeon's office for the surgery and 1 for the post-op care?
"e.g.", The surgeon's office bills for the surgery (66984-54) and the patient's insurance applies a copay. Then another Doctor (not from same group) does the post-op care (66984-55) and the insurance applies another copay. Isn't the post-op care included in the initial charges and the patient should be charged only 1 copay?
SuperCoder Posted 1 month ago #

Services not included in the global surgery payment and may be billed and paid for separately: services of other physicians related to the surgery, except where the surgeon and the other physician 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.
User id : 32457 Posted ago #

The answer given does not answer my question. The patient had cataract surgery and the surgeon bills ins. for the proc. (66984-54). The patient is then seen by another doctor for the post-op care (related to surgery) and bills ins. for (66984-55). The patient has signed an agreement for transer of care. The insurance company is applying a patient copay to the surgeon's claim and the post-op care physician's claim. Shouldn't the post-op care be included in the Global period and the patient only have 1 copay?
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SuperCoder Answered Thu 05th of December, 2013 07:23:15 AM


We appreciate your concerns. We will get back to you soon.


SuperCoder Answered Thu 05th of December, 2013 21:32:54 PM

The answer to this question can only be found in the patient's individual policy. The insurance may very well be requiring the patient to pay another copay but it should be stated very clearly in the policy what the patient responsibility is. A "co-pay" usually refers to an office visit or an office procedure. However, for surgeries, it is usually a "co-insurance" that is applied and the insurance company may be actually requiring a co-insurance on the surgical portion as well as the post-op portion. In any case, a close review of the explanation of benefits is needed, as well as the patient's policy is needed before this can be answered correctly.

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