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Maurice Posted Tue 31st of July, 2012 20:32:17 PM

If the on call neurosurgeon visits other neurosurgeon's patients in the hospital while doing his/her round on patients and some of them are post operative, may he/she bill for those visits because he/she was not the primary surgeon? There is no transfer of care being done in this situation. Thank you.

SuperCoder Answered Wed 01st of August, 2012 14:22:22 PM

No, he can't. The CPT manual specifically states in the Evaluation and Management Services Guidelines section (preceding Chapter 1): "In the instance where a physician is on-call for or covering for another physician, the patient's encounter will be classified as it would have been by the physician who is not available." Therefore, it would be incorrect to bill for an office visit performed by the on-call physician during the post-op, because the covering on-call physician is, indeed, subject to the same guidelines as the physician he is covering.

If this had been a problem unrelated to the original surgery, then the on-call physician would be able to bill the office visit for an established patient with modifier -24 (Unrelated evaluation and management service by the same physician during a postoperative period) and an unrelated diagnosis code.

Maurice Posted Wed 01st of August, 2012 21:37:23 PM

Thank you

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