# E/M during Global Period?



## heatherbrienne@gmail.com (Jun 28, 2013)

One of my physicians performed a craniotomy on a patient, patient was seen by the nurse two weeks later for an incision check, the physician consulted with the patient following nurse visit for a Radiosurgery consult. Same diagnosis but physician consulted patient, discussed risks and benefits of radiosurgery and the treatment of not only the cavity from where the resected tumor was but additional mass/lesions . Can this be billed as an E/M with modifier? Would modifier 24 be appropriate? or both visits billed as post op?
Thank you for your help


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## maddismom (Jun 28, 2013)

I would say no.......


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## mhstrauss (Jun 28, 2013)

heatherbrienne@gmail.com said:


> One of my physicians performed a craniotomy on a patient, patient was seen by the nurse two weeks later for an incision check, the physician consulted with the patient following nurse visit for a Radiosurgery consult. Same diagnosis but physician consulted patient, discussed risks and benefits of radiosurgery and the treatment of not only the cavity from where the resected tumor was but additional mass/lesions . Can this be billed as an E/M with modifier? Would modifier 24 be appropriate? or both visits billed as post op?
> Thank you for your help



Is the physician that was "consulted" the same physician that performed the crani surgery?


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## lcashburn (Jul 3, 2013)

*Consult for radiosurgery following surgery*

If the physician's documentation is complete and this is a new medical management issue (this conversation didn't also take place prior to surgery) then I would say yes.  However, generally the consultation would be done by a radiation oncologist rather than a neurosurgeon, unless the neurosurgeon routinely works with the radiation oncologist to plan all the brain cases.  But the radiosurgery is definitely a separately identifiable medical management item rather than a follow-up on the surgery.


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## heatherbrienne@gmail.com (Jul 9, 2013)

Yes the same physician that did the crani also did consult for radiosurgery


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## mhstrauss (Jul 9, 2013)

heatherbrienne@gmail.com said:


> Yes the same physician that did the crani also did consult for radiosurgery



See link from CMS, page 3, "Not included in the surgical package":

http://www.cms.gov/Outreach-and-Edu...oducts/downloads/GloballSurgery-ICN907166.pdf

"Treatment for the underlying condition, or an added course of treatment that is not part of normal recovery from surgery".... Sounds like the radiosurgery consult does fit into this category, since he is going beyond "just a wound check", and an E/M is billable for this visit.  I'm not so sure it should be a "consult" per se, if he is continuing to treat the patient, but more likely an established patient E/M with mod 24...just my 2 cents. Hope this helps!!


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