# Discharge part of post op global?



## hsmith67 (Jul 30, 2011)

Patient is referred to general surgery (seen in office). Patient is diagnosed with colon cancer, is admitted as inpatient, undergoes colectomy by general surgeon, is followed post op, and discharged home. Is the discharge (99238) typically part of global, typically payer specific, or what? I would have thought the 99238 would have been paid, but payer is saying "A coding error was detected. Payment for this post op was included in the surgical." Any ideas?

Thanks for any help.
Hunter Smith, CPC


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## jewlz0879 (Aug 1, 2011)

Yes, the discharge is normally included in the procedure. They look at it like this: you have to admit the patient for the procedure so discharge is part of it too; on the same day. Now, if they are discharged days after or event the next day, then yes, 99238 can be billed.


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## FTessaBartels (Aug 3, 2011)

*Post op care*

The payment for the procedure includes all post-op care (including discharge and office visits) for 90 days. 

Discharge is NOT separately billable. 

Hope that helps.

F Tessa Bartels, CPC, CEMC


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## hsmith67 (Aug 5, 2011)

*Thanks*

Thanks very much for your help!

Hunter Smith, CPC


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## gski (Aug 8, 2011)

These 2 responses contradict each other.  Julie & F Tessa, do either of you have documentation to support your statements?  I am under the belief that the discharge is included only on the same date of a procedure.  Thank you for clarifying this.


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## FTessaBartels (Aug 11, 2011)

*Facility requirement vs billing*

Do not confuse a requirement from the facility for a discharge summary with whether you can separately bill for discharge day management.

A hospital (or other facility) may have requirements for specific paperwork, including a dictated discharge summary.  The physician must comply with those requirements if s/he expects to continue to have privileges at that facility. 

Regardless, if the procedure performed has a global period, AND the discharge falls during that global period, then the discharge (like any other E/M code) is considered part of routine post-operative care and is NOT separately billable. 

Hope that helps.

F Tessa Bartels, CPC, CEMC


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## gski (Aug 15, 2011)

Thanks for the info!  This has been a greatly debated issue.


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## YLG74 (May 7, 2021)

FTessaBartels said:


> *Post op care*
> 
> The payment for the procedure includes all post-op care (including discharge and office visits) for 90 days.
> 
> ...


Hello ladies, I agree with the statement and point of view. but I am getting push back and require a source of truth and acceptable citation. help??  TRIED USING _Pub 100-4, Ch.12, §30.6.6 A_


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## csperoni (May 7, 2021)

I refer to the Medicare global surgery booklet frequently. If the surgeon is managing the inpatient stay, those standard visits (and discharge) are not payable in the global period.
Specifically:
What services are *included *in the global surgery payment?   Medicare includes the following services in the global surgery payment when provided in addition to the surgery:
• Pre-operative visits after the decision is made to operate. For major procedures, this includes pre-operative visits the day before the day of surgery. For minor procedures, this includes pre-operative visits the day of surgery.
• Intra-operative services that are normally a usual and necessary part of a surgical procedure
• All additional medical or surgical services required of the surgeon during the post-operative period of the surgery because of complications, which do not require additional trips to the operating room
*• Follow-up visits during the post-operative period of the surgery that are related to recovery from the surgery*
• Post-surgical pain management by the surgeon
• Supplies, except for those identified as exclusions
• Miscellaneous services, such as dressing changes, local incision care, removal of operative pack, removal of cutaneous sutures and staples, lines, wires, tubes, drains, casts, and splints; insertion, irrigation, and removal of urinary catheters, routine peripheral intravenous lines, nasogastric and rectal tubes; and changes and removal of tracheostomy tubes

What services are *not included* in the global surgery payment?   The following services are not included in the global surgical payment. These services may be billed and paid for separately:
•  Initial consultation or evaluation of the problem by the surgeon to determine the need for major surgeries. This is billed separately using the modifier “-57” (Decision for Surgery). This visit may be billed separately only for major surgical procedures.
• Services of other physicians related to the surgery, except where the surgeon and the other physician(s) 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.
• Visits unrelated to the diagnosis for which the surgical procedure is performed, unless the visits occur due to complications of the surgery
•  Treatment for the underlying condition or an added course of treatment which is not part of normal recovery from surgery
• Diagnostic tests and procedures, including diagnostic radiological procedures
• Clearly distinct surgical procedures that occur during the post-operative period which are not re-operations or treatment for complications
• Treatment for post-operative complications requiring a return trip to the Operating Room (OR). An OR, for this purpose, is defined as a place of service specifically equipped and staffed for the sole purpose of performing procedures. The term includes a cardiac catheterization suite, a laser suite, and an endoscopy suite. It does not include a patient’s room, a minor treatment room, a recovery room, or an intensive care unit (unless the patient’s condition was so critical there would be insufficient time for transportation to an OR).
• If a less extensive procedure fails, and a more extensive procedure is required, the second procedure is payable separately.
• Immunosuppressive therapy for organ transplants
• Critical care services (CPT codes 99291 and 99292) unrelated to the surgery where a seriously injured or burned patient is critically ill and requires constant attendance of the physician.

I usually prefer the Medicare booklet over the claims processing manual, which is written from a more legal standpoint and not so much in plain language.  That being said, the _Pub 100-4, Ch.12, §30.6.6 __A_ referenced also clearly states it is only billable with -24 IF UNRELATED to surgery.  
A. CPT Modifier “*-24” -* Unrelated Evaluation and Management Service by Same Physician During Postoperative PeriodA/B MACs (B) pay for an evaluation and management service other than inpatient hospital care before discharge from the hospital following surgery (CPT codes 99221-99238) if it was provided during the postoperative period of a surgical procedure, furnished by the same physician who performed the procedure, billed with CPT modifier “-24,” *and accompanied by documentation that supports that the service is not related to the postoperative care of the procedure.  They do not pay for inpatient hospital care that is furnished during the hospital stay in which the surgery occurred unless the doctor is also treating another medical condition that is unrelated to the surgery.  All care provided during the inpatient stay in which the surgery occurred is compensated through the global surgical payment.*


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## vmatt (Oct 20, 2022)

Thank you Christine.  My providers are always looking for ways to bill for the discharge. I appreciate the information and will be glad to have something for them to refer too.  Thanks


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