Pulmonology Coding Alert

Question: If physician 1 in our group practice provides post-op care for a patient whom physician 2 operated on, can physician 1 bill for his services?

Texas Subscriber Answer: Payers will treat two physicians within a practice as one when caring for a patient. Therefore, when your pulmonologist performs an operation, and another physician from your same practice performs the postoperative follow-up within the postoperative global period, you may not report the follow-up care separately. 

Either physician can report a follow-up visit after the postoperative global period ends. Minor surgical procedures have a 0- or 10-day global period. Major surgical procedures typically carry a 90-day global period. 

Endoscopic procedures do not have an associated postoperative period. If you report an E/M on the same day as an endoscopic procedure, the E/M must involve care that is above and beyond the typical pre- and post-op care associated with the procedure and it must be a separately identifiable procedure. 

If you want to find a global period assignment, you can refer to the Physician Fee Schedule, available through your local Medicare carrier or Addendum B of the Nov. 15, 2004, Federal Register at www.gpo.gov.

If your pulmonologist performs an operation and a second physician from your practice needs to take the patient back to surgery for a complication within the global period, the second physician may report the procedure by appending modifier -78 (Return to the operating room for a related procedure during the postoperative period) to the appropriate CPT code.