Reimbursement Strategies for Treating Patients After Cardiac Surgery
Published on Wed Dec 01, 1999
After a patient undergoes cardiac surgery, the surgeon often passes the care of the patient over to a cardiologist. Billing for such care can be difficult because it frequently is included in the surgerys global period. But through proper coding and clear communication between physicians, cardiologists can ensure they maximize their reimbursement for the follow-up treatment they provide.
Practice Stance Required
To get paid for treating a cardiac surgery patient, cardiologists need to be proactive. Depending on the circumstances, this could mean:
- Coordinating a transfer of care from the cardiac surgeon
- Billing for a consult with the appropriate documentation
- Demonstrating that the care is concurrent and unrelated directly to the surgery
- Billing for office visits, even though the surgery has a 90-day global period
For cardiologists, these situations can be delicate because some surgeons expect to be reimbursed for the entire surgical procedurea percentage of which will include postoperative care for the duration of the global periodeven though such care has been handed off to the cardiologist, says Susan Callaway-Stradley, CPC, CCS-P, an independent coding consultant and educator in North Augusta, SC. She notes that if cardiac surgeons know a cardiologist is going to see the patient after the surgery, they may leave the postoperative care to the cardiologist but still bill for the entire procedure, which includes preoperative, intraoperative and postoperative care.
The problem with that, Callaway-Stradley says, is that the Health Care Financing Administration (HCFA) and third-party payers will not reimburse two physicians for rendering routine postoperative care for the same patient.
Consequently, many state American College of Cardiology (ACC) groups now advise their members not to provide care for a cardiac surgeons patients unless they receive a clear understanding in writing about the co-management of the patient that indicates the cardiologist will be paid part of the procedures global fee.
Further complicating the issue is the nature of the care provided by the cardiologist during the postoperative period. If the cardiologist sees the patient for a problem that is not directly related to the surgery, he or she is free to bill for those services, whether in the hospital or post-discharge, if there is supporting documentation to that effect.
But if the cardiologist is simply providing routine postoperative care, It is important for cardiovascular surgeons and cardiologists to communicate and delineate their respective areas of responsibility, according to the ACC. In other words, a transfer of care from the cardiovascular surgeon to the cardiologist needs to occur. Otherwise, says the ACC, the cardiovascular surgeon expects that the cardiologist will refrain from providing services to patients who have had cardiovascular surgery, unless the surgeon requests a consultation from the cardiologist about a specific problem [...]
