Part B Insider (Multispecialty) Coding Alert

Question: Our physician readmitted a patient who was in a global period for a procedure done by a different physician from a different group. Our physician was on call, and that’s why he saw this patient. Can I bill a hospital visit?

Answer: The answer depends on whether your physician had an agreement with the other physician (or the other group) to cover for the other physician.

Option 1: If your physician was covering for the other group by a previous arrangement for reciprocal coverage, then he acted as the covered physician and would be included in the first physician’s surgical global. Therefore, he would not bill for the care he provided to the patient in the hospital within the global period of the surgery. 

Option 2: If your physician had no previous arrangement to cover the other group, but was on call for the emergency room and was asked initially to see this patient in the emergency room, your physician was not restricted by another unrelated physician’s global surgical period. In this case you may bill for your physician’s services. For example, if the patient was admitted, and your physician performed the initial inpatient encounter, report the appropriate code from 99221-99223 (Initial hospital care, per day, for the evaluation and management of a patient …).

Your physician may later transfer the patient back to the other group when the group resumes their own coverage, but that doesn’t mean you can’t report the hospital care that your physician provided.