Wiki 90 day global period E & M services

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motherbyrd

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Pinebluff, NC
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My Oncologist/Gynocologist is insisting that he should be reimbursed for all of his E & M services even when he brings the patient back two weeks post op for discussion and counseling of treatment. I have explained that if the visit is unrelated to the surgery I can bill with a -24 modifer. I have contacted Medicare, BCBS and several other carriers and they have advised that a 90 day global means that all E & M services that are related to the cancer surgery (ie hysterectomy) are included in the global. Any suggestions on what I might be overlooking?
 
If the discussion is regarding chemo or radiation treatment then that counseling is not related to the surgery or the recovery from the surgery. Just because Cancer is the end result of the surgical operation does not make the Cancer issues part of the global. The surgical issues are a part of global, such as dressings and sutures and post operative infections, Sedona, hematomas , pain at the incision site, and so on. But the disease process is not part of the surgery and should not be considered part of global.
 
Those visits are billable, such as when chemo counseling is done. This is payable by Medicare, per both ACOG and SGO. Use diagnosis codes V65.49 and the cancer diagnosis and the 24 modifier. Appeal denials.
 
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