Medicare Compliance & Reimbursement

Initial consultation, diagnostic tests are also fair game Question: If a neurosurgeon calls our orthopedic surgeon to the operating room to assist, does the global period apply to the orthopedic surgeon? Ohio Subscriber Answer: No. The global period applies only to the primary surgeon, not to the assistant surgeon. For future reference: According to "Global Surgery: Questions and Answers" by Palmetto GBA, the Part B Medicare carrier for Ohio, you may separately submit "services of other physicians except where the surgeon and other physician(s) agree on the transfer of care." Services a surgeon may submit separately during the global period also include: • initial consultation or evaluation (for major surgeries only) • visits unrelated to the diagnosis prompting the surgery, unless the visits occur due to surgery complications (append modifier 24, Unrelated evaluation and management service by the same physician during a postoperative period; or 25, Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) • treatment outside of the normal surgery recovery (append modifier 24) • diagnostic tests and procedures • clearly distinct surgical procedures by the original surgeon during the post-op period, which are not re-operations or treatments for complications (append modifier 58, Staged or related procedure or service by the same physician during the postoperative period; or 79, Unrelated procedure or service by the same physician during the postoperative period) • postoperative complication treatment requiring a return to the operating room (append modifier 78, Unplanned return to the operating/ procedure room by the same physician following initial procedure for a related procedure during the postoperative period) • a more extensive procedure required if a less extensive procedure fails (append modifier 79) • immunosuppressive therapy the surgeon provides (append modifier 24) • critical care services (99291 and 99292) unrelated to surgery for critically injured or burned patients who require constant attention from physician (append modifier 25 [pre-op] or 24 [post-op], and submit with an ICD-9 code from 800.00-929.9 or 940.0-959.9). Resource: You can find this list online at http://www.palmettogba.com.