Pulmonology Coding Alert

Question: Can our practice bill for immunosuppressant visits during the global period following a lung transplant?

California Subscriber

Answer: A provider may separately bill for visits involving immunosuppressant therapy that occur during the 90-day global period of a lung transplant. However, you must make sure to have the correct modifier appended to these claims. You’ll find all MACs and most commercial payers have guidelines that advise the use of modifier 24 (Unrelated evaluation and management service by the same physician or other qualified health care professional during a postoperative period) for immunosuppressive therapy visits following transplants during the global period timeframe.

In some cases, the pulmonologist sees the patient following the surgery, but a different physician performed the actual surgery. If you are seeing a patient to evaluate their lung health and perform the immunosuppressant therapy but you (or your partners who are the same specialty as you) weren’t involved in the surgery, you are not subject to the global period and you need not worry about the global period.

In cases where the lung transplant took place at a specialty hospital far away and the pulmonologist in your town took over aftercare, then the pulmonologist may be able to report the surgical code with modifier 55 (Postoperative management only) appended to reflect the fact that they handled all aftercare. The transplant surgeon would report the surgical code with modifier 54 (Surgical care only) appended to show they only handled the surgery and not the aftercare.