Primary Care Coding Alert

Although family practitioners (FPs) rarely perform major surgery, they do conduct minor surgery and manage pre- and postoperative services. To avoid miscoding a service, it is important to know what is included in the global period, the normal follow-up care for surgery and what falls into postoperative careespecially if during the post-operative period the patient suffers from problems unrelated to the surgery.

According to Medicare, a global surgery package includes preoperative, interoperative and postoperative serviceswith the postoperative period varying depending on the type of surgery, says Emily Hill, a physician assistant and president of Hill and Associates, a coding and compliance consulting firm in Wilmington, N.C. Although the postoperative care is included in the global package, you should know the incidents where those services fall outside.

Thomas Kent, CMM, principal of Kent Medical Management, a medical office management and coding consulting firm in Dunkirk, Md., cites a rule of thumb about global days, normal care follow-up after surgery. If no incision is made, there are zero global days; if a minor incision is made 10 global days are allotted; and for major incisions the global period is 90 days. He also points out that orthopedic procedures carry 90 global days, whether an incision is made or not. If in doubt about what constitutes a global period, contact the Health Care Financing Administration (HCFA) at 410-786-6830.

Different scenarios illustrate how confusion may arise over whats included in the global period and what services fall into postoperative care.

Scenario #1: After an examination with his family practitioner (FP), a 70-year-old patient with hypertension needs bladder surgery to remove a tumor. Since he lives in a small town, the patient is sent to a surgeon in the nearest larger city, where there is a tertiary care center. Once the surgeon has deemed the surgery necessary, the surgeon requests that the family physician conduct a preoperative examination to ensure the patient can withstand anesthesia. Medicare will pay if the exam proves to be a medical necessity, which in this case would likely be due to the patients hypertension.

The FP should code 99241-99245 (office consultation for a new or established patient) for the preoperative evaluation requested by the surgeon. Kent says that many FPs dont realize its a consultation and instead code for an office visit. In addition to the consultation code, the FP should use three diagnostic codes402.91 (hypertensive heart disease, unspecified, with congestive heart failure) for the systemic problem; 223.3 (benign neoplasm of kidney and other urinary organs, bladder), the reason for the surgery; and V72.81 (preoperative cardiovascular examination), the reason for the physical exam. Alternatively, if the patient has no other problems, the FP would code 223.3 and V72.84 (preoperative [...]