Ob-Gyn Coding Alert

Question: I have a physician who wants to bill for inpatient daily care (99231-99233) after a major surgery (90-day global) because she has a diagnosis of malignancy and thus can sometimes spend 40 minutes with the patient and family discussing coordination of care and/or counseling. She think it's not global, but I think it is. Who's right?


Texas Subscriber

Answer: Under CPT guidelines, the global service includes talking to the patient or the patient's family or other physicians in the immediate postoperative period. If your physician is organizing chemotherapy for the patient, you can bill this type of service outside of the global.

Although the -where we go from here- talks frequently take place after the ob-gyn discharges the patient, they can also happen while the patient is still hospitalized. To bill this service, you would only include that part of the rounding visit that represents the counseling and coordination of care dealing with further treatment--an event that probably is not going to be happening every day the patient is in the hospital.

You will have difficulty getting this paid by the carrier, however, even if you use modifier 24 (Unrelated evaluation and management service by the same physician during a postoperative period) on your E/M code because your diagnosis is usually going to be the same as the one used for the surgery (unless this was an encounter for chemo).