Medicare Compliance & Reimbursement

Question: If I see a patient after his radical prostatectomy within the global period, and I evaluate and manage his incontinence and ED, can I bill a separately identifiable E/M within the global period? Or, would this be considered included in the global period?

Answer: The answer will depend upon whether your patient had the incontinence and erectile dysfunction (ED) prior to his prostatectomy or if these problems are complications of the prostatectomy, says Alice Kater, CPC, PCS, coder for Urology Associates of South Bend, Ind.

If these are past conditions, and you have clear documentation that incontinence and ED were existing conditions unrelated to the prostatectomy, you should bill the appropriate evaluation and management code, such as 99214 (Office or other outpatient visit for the evaluation and management of an established patient …). You should append modifier 24 (Unrelated evaluation and management service by the same physician or other qualified health care professional during a postoperative period), says Kater.

If the conditions are complications directly resulting from the prostatic surgery, and were not present before the radical prostatectomy, you may not be able to bill for the office visit. “That said, some commercial payers would allow reimbursement for treatment of complications,” Kater says. ”Medicare, however, does not. You need to know your payer.