SuperCoder Posted Thu 28th of July, 2011 19:28:48 PM
can i use a mod for a discharge on global
SuperCoder Answered Fri 29th of July, 2011 03:42:59 AM
Successfully Bill for Subsequent and Discharge Services
Global packages also affect whether surgeons may bill for discharging patients. The Office of the Inspector General (OIG) is currently probing physician billing for discharge day management (99238, hospital discharge day management; 30 minutes or less; 99239, more than 30 minutes). A lot of surgeons are billing these codes even though HCFA regulations clearly state discharge day management services are already included in the postoperative global period.
However, even though Medicare and private carriers will not pay for discharge services considered part of a global package, some carriers may pay discharge services if the patient receives a second, unrelated diagnosis. In these situations, hospital discharge management should be billed.
For example, a patient who had an open appendectomy goes into urinary retention the next day and is seen by the surgeon. The surgeon can bill a subsequent hospital visit (99231-99233) with a -24 modifier for every day he or she visits the patient, using a new diagnosis of urinary retention (788.2), provided there is indication in the documentation that urinary retention is being treated.
The note should support the contention that this is not a complication of the original surgery; this is a new, unexpected problem. The surgeon also may be able to bill for the discharge using the hospital discharge day management codes (99238-99239) with a -24 modifier attached, depending on the carriers policy. Consult your carrier rules to find out if the discharge E/M may be claimed, and be sure to obtain the answer in writing.
For all claims involving reimbursements during a global period, it is recommended to coders to submit an indications paragraph in the operative report to give a mini-history, because the person reviewing the claim for the carrier doesnt have the hospital chart to check it against.
Even more than usual, successful reimbursement for procedures or visits during global periods is contingent on appropriate documentation of medical necessity.