# Separate visit or global?



## jdibble (Sep 2, 2010)

I have an issue I need to settle for our Plastic Surgeon - hopefully someone can answer this for me.  

The surgeon took the patient to the OR and performed a lesion removal of a melanoma, with a complex closure.  The patient returned to ER 6 days later with drainage from the incision site and the ER doc called in the Plastic Surgeon for a consult.  Now our surgeon wants to bill for the Consult.  I explained to her that it is part of the global as this was a complication from the surgery (this is a Medicare patient).  She is insisting that it should be covered because she ordered an INR for the patient who is on Coumadin and wants me to bill with 24 modifier.  I tried explaining that this is still global as the reason for the visit was for the surgical wound, but she wants verification of this.  

Can some one let me know if I am right or wrong and where I can get this information in writing.  She is also upset about not knowing how to figure out what the global period is on her procedures.  All of my other surgeons or their office staff always knew what the global period was for the surgeries they performed and I did not have to provide them this information.  Is there a source where I can send her so that she or her staff can look up this information so that she knows when to charge for an office visit or when it is global.

Thanks for any help!


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## FTessaBartels (Sep 8, 2010)

*Global*

I agree that this is global to the original procedure.

Don't get into a fight with this physician. It won't help either of you.

I made a list of all the procedures with 0 or 10 global days that our plastic surgeons typically perform (lots of lesion removal codes, laceration repairs, etc).  I gave them that list. Everything else is 90 days.  It wasn't that hard to come up with and they went away with a feeling that I was genuinely helping them. Makes for a nicer working relationship and they are more likely to listen to my advice in the future.

I work in Pediatrics so we don't generally deal with medicare patients, but you are correct that CMS indicated a year or more ago that NO visits - even for complications - would be paid during the global period. This includes hospitalization (e.g. patient with serious wound infection and dehisence who requires admission for IV antibiotic). They will pay for a return to the OR for a corrective procedure, but no visits. 

Hope that helps.

F Tessa Bartels, CPC, CEMC


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## Stefanie (Sep 8, 2010)

Below is the link for Trailblazers Medicare "Surgery Manual" it spells out exactly what is included in a surgical global period.  I hope it helps.  It also tells you where you can find the global period for each surgical procedure.  

http://www.trailblazerhealth.com/Publications/Training Manual/Surgery.pdf


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## jdibble (Sep 9, 2010)

Thanks Tessa and Stefanie for the help.  

I was able to find a place to print out all of the global periods for the Integumentary System - which is the majority of the codes this doc performs and have sent it to her, along with a copy of the NCCI manual page that states that complications are included in the global unless it requires a return to the OR.

I am trying to find a source where I can find answers to my questions about correct coding for her procedures and where I have documentation in writing for this as she seems to want to question every step of the coding of her surgeries.  If anyone knows where I can access this information, that would be very helpful.

Thanks again!


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## FTessaBartels (Sep 24, 2010)

*American Society of Plastic Surgeons*

Jodi,
The ASPS has regularly scheduled seminars on coding for Plastic Surgeons.
I attended one of their 2-day seminars a couple of years ago. 
Attendees ranged from newly-hired office personnel to surgeons. Very helpful and informative. Start at http://www.plasticsurgery.org/

Your practice might also want to invest in a Coding Companion for Plastics/OMS/Dermatology - the one I have is published by Ingenix. 

Hope that helps.
F Tessa Bartels, CPC, CEMC


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## jdibble (Sep 28, 2010)

Thanks Tessa!  I had already given my manager my request for the Coding Companion book and am patiently waiting for it's arrival!  I will also check into the seminars for coding, as my manager has advised me they would pay for me to attend if I could find one! I appreciate all your help!


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