Urology Coding Alert

Question: Our physician readmitted a patient that was in a global period for a procedure done by a different surgeon from a different group. Our physician saw this patient because he was on call. Can I bill for a hospital visit?

Vermont Subscriber

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

Option 1: If your physician by a previous arrangement for reciprocal coverage was covering for the other group, then he acts as the covered physician and would be included in the first physician’s surgical global. Therefore, he cannot 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 is on call for the emergency room and is asked initially to see this patient in the emergency room, he is then not restricted by another unrelated physician’s global surgical period. In this case you may bill for his services. For example, if the patient is admitted, and your urologist performs 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 urologist may then 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 he provided.