Orthopedic Coding Alert

Question: My practice just hired a physiatrist and Im at a loss as how to bill for her services. For example, one of our surgeons performs a knee replacement (27447). While the patient is still in the hospital, the physiatrist takes over the care including hospital visits, patient orders, etc. But with the patient in a global period, how should I bill? If the physicians are not waiting to see if the patient is having problems or needs pain management, wouldnt her care fall under the global period?

April Lytle, CPC
Columbus, Ohio

Answer: Billing for the physiatrist will depend on many issues. For example, is your physiatrist an employee or a partner of the group? What does his or her contract specify? Are you billing under the same tax ID number? Since the physiatrist is of a different specialty, she certainly can charge separately for her services, even in the global period. On the post-op total joint replacement, you need to establish the reason for physiatric evaluation and treatment. If its strictly for a rehabilitation program, the physiatrist can bill for rehabilitation evaluation services, with the appropriate V code(s) to identify the patients postoperative state.

If the physiatrist is truly taking over all of the postoperative care, for both the physiatrist and the surgeon to get paid, submit the surgeons charge with modifier -52 (reduced services) to identify the pre- and intra-operative periods only, and then bill the same code with modifier -55 (postoperative management only) appended to identify postoperative care by the physiatrist. You will need the date that the surgeons care ends and the date the physiatrist takes over, and you will then be paid a percentage for each, an amount that equals 100 percent as if one provider billed for the entire service.

Some Part B carriers may offer an alternative to billing the charges separately. According to the September 2000 NHIC (National Heritage Insurance Company) bulletin, When different physicians in a group practice participate in the care of a patient the group should bill for the entire global package, if the physician reassigns benefits to the group. Indicate on the claim for the physician who performs the surgery as the performing physician.

This policy indicates that there would have to be some sort of internal adjustment of payment for services.