lynn Posted Wed 16th of March, 2016 14:27:26 PM
I work in a Cardiology practice. MD is double boarded (internal med/cardio). Not all our procedures have global days. My question is: for the procedures that DO have global days for example 33208. I understand that global includes the day before the procedure--all rounds/follow up and discharge for 90 days after the procedure--so really it's 92 days. IF the MD/surgeon keeps the patient in the hospital and is rounding for another diagnosis other than the surgery diagnosis--can he bill for those rounds? It might be for syncope, blood pressure, etc., And that same question applies to his office clinic also--if seen with different dx--can we bill? If the answer is yes that he CAN bill w/different dx---what are the documentation requirements (since records will probably be requested at least by Medicare)? Some patients will need medication follow up/change, discuss lab work related to heart or other medications, etc., and not to mention device programming--I assume they only get 1 device programming"included" in the global period with the implant of aicd/pm? If you can please respond in writing I would be greatly appreciative.
SuperCoder Answered Thu 17th of March, 2016 06:30:03 AM
The 90 day period for remote interrogation services only applies to the remote services related to the device. If a separately, identifiable E/M service is provided during the remote 90 day service period, the E/M may be billed separately. A -25 modifier may apply if billed on the same day as the remote service. Different rules apply for E/M
within the 90 day global period for a pacemaker or ICD device implant/replacement
If visit is related to complication from the procedure for example, blood pressure it is not separately payable.
Patients need for medication follow up/change, discuss lab work related to heart or other medications, etc is included in global period.
During the global period (90 days) of a pacemaker or ICD device implant/replacement the programming evaluation,interrogation evaluation codes are not applicable to the 90 day global period. Per the Medicare Claims Processing Manual, Chapter 12 – Physicians/Non-Physician Practitioners, Section 40.1 diagnostic services and tests are excluded from the 90 day global period. Therefore, interrogations performed within the 90 day global of a device implant are not included in the global period and may be billed separately. Multiple interrogations are expected to be performed within the 90 day period however only one code can be reported for those interrogations per 90 days.
This applies to both the physician professional codes as well as the technical remote monitoring code. If payers allow more frequent billing based on medical necessity it will be published by each individual payer/Medicare contractor in local coverage determinations (LCDs).
Please let me know if any other questions.