General Surgery Coding Alert

How can you code if a physician in your group practice treats a patient during the global period of a procedure performed by another surgeon in the practice? If you think that payer guidelines dictate that you must write off such visits, youre missing out on deserved reimbursement, particularly if a physician of another specialty within your practice sees the patient for a separate procedure. Use Modifiers to Separate Surgeries Because surgeons in a group practice typically share the same tax identification number, Medicare considers them the same physician for billing purposes. This can mean that you may be unable to bill for subsequent surgeries during a global period for surgeons of the same specialty, unless you use modifiers correctly to unbundle the procedures.
 
For instance, Dr. Jones performs hernia repair (49560, Repair initial incisional or ventral hernia; reducible) on a 48-year-old male patient. Nine weeks later, the patient  overdoes it during a softball game at a family reunion, causing the hernia to recur. Dr. Smith, of the same group practice as Dr. Jones, performs the second repair (49565, Repair recurrent incisional or ventral hernia; reducible)
during the global period of the initial surgery. Because the initial repair carries a 90-day global surgical period, you might guess that Medicare will bundle the second hernia repair surgery into the surgical package.
 
In fact, Medicare will bundle the first and second hernia repairs unless you append modifier -79 (Unrelated procedure or service by the same physician during the postoperative period) to 49565, says Barbara Cobuzzi, MBA, CPC, CPC-H, CHBME, president of Cash Flow Solutions Inc., a Lakewood, N.J., reimbursement consulting firm. Otherwise, she says, the carrier will consider it bundled into the global period of the first hernia repair surgery. Section 15501H of the Medicare Carriers Manual (MCM) specifically states, Physicians in the same group practice who are in the same specialty must bill and be paid as though they were a single physician. 
 
If the same surgeon performs both surgeries, you should append modifier -79 to the second procedure. You should follow that same logic, therefore, if two different surgeons in the same practice perform the two surgeries. Also, your carrier will launch a new global period starting on the date that you performed the recurrent hernia repair, says Dianna Hofbeck, RN, CCM, ACFE, president of North Shore Medicine Inc., a national billing service in southern New Jersey. Even though only about 30 days remained on the patients original global period, he will be under the new global period for an additional 90 days, she says. Modifiers Arent Necessary for Different Specialists If two surgeons in your group practice of different specialties attend to the same patient during a global period, you need [...]