Medicare Compliance & Reimbursement
Check MAC Rules for Non-Reimbursable Postoperative Visit Submissions
Question: For a postoperative, related evaluation and management (E/M) visit within the global surgery period, should I still submit the claim to the payer despite the inevitable denial? Or is it common practice to code the claim and then immediately write it off? Georgia Subscriber Answer: In the case of postoperative E/M visits, you should review your practice’s guidelines as to whether or not it typically bills for (related) postoperative claims within the global period. Whether or not you end up submitting to the payer, you should use code 99024 (Postoperative follow-up visit, normally included in the surgical package, to indicate that an evaluation and management service was performed during a postoperative period for a reason(s) related to the original procedure) for postoperative services that are included in the original surgery’s global surgical package. Additionally, you should check your Medicare Administrative Contractor (MAC) guidelines. These policies vary from MAC to MAC and you may be required to submit the claim despite the zero charge. Since this is a zero-charge code, your submission of this claim to the payer would be for documentation purposes alone. Make sure you clearly understand what services are and are not included in the 10- and 90-day global surgery periods. You can find out more by reading the global surgery booklet here: www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/GloballSurgery-ICN907166.pdf.
Medicare Compliance & Reimbursement
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Check MAC Rules for Non-Reimbursable Postoperative Visit Submissions
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