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Maria Posted Fri 12th of July, 2013 14:06:10 PM

I have a hospitalist that is consulting on inpatients for a neurosurgeon. The hospitalist sees the patient, documents, then the Neurosurgeon reviews and co-signs the note(similar to they do for NPs) sometimes with additional documentation, sometimes not. If the hospitalist does not bill for this documentation, can the neurosurgeon even though most/if not all of the documentation is the hospitalists?

SuperCoder Answered Mon 15th of July, 2013 12:01:24 PM

A hospitalist might be required to admit and follow surgical patients who have no other identifiable chronic or acute conditions aside from the surgical problem. In these cases, hospitalist involvement may satisfy facility policy (quality of care, risk reduction, etc.) and administrative functions (discharge services or coordination of care) rather than active clinical management. This “medical management” will not be considered “medically necessary” by the payor, and may be denied as incidental to the surgeon’s perioperative services. Erroneous payment can occur, which will result in refund requests, as payors do not want to pay twice for duplicate services. Hospitalists can attempt to negotiate other terms with facilities to account for the unpaid time and effort directed toward these types of cases.

If the hospitalist is asked to give an opinion on whether a patient can undergo surgery, bill either an inpatient or outpatient consultation code, depending on the setting. A consultation would not be considered part of the global package. According to my source at Medicare: If a consult is not being requested, a transfer of care has not occurred, and a preop service is done within the global period by another physician who is not part of the group doing the surgery, you would bill for the service as a hospital visit. If a transfer of care has taken place, however, a routine preop exam and/or postop care could be considered part of the global period. In this situation, you would have to carve out billing for preop or postop management services by using either the preoperative modifier (-56) or the postoperative-management-only modifier (-55). (Keep in mind that Medicare does not recognize modifier -56, so just bill the service without the modifier for Medicare patients.) Use the modifier in conjunction with the surgery CPT code being billed by the surgeon. Surgeons aren’t fond of this option because it divvies up the global payment between the hospitalist and the surgeon. The surgeon should also use modifier(s)—such as the surgical care only modifier, -54—to represent that portion of the global period he or she performed. More information on Medicare’s global surgery guidelines is online. The pertinent section is 100-4, chapter 12, section 40.

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