Wiki Assistant at Surgery - Global Period

[kristina.l.bennett@osfhealthcare.org]

I have a physician questioning if the global period applies to him when he was the "assistant at surgery". He feels that the global period does not apply when he is only the assistant and can bill for sub visits. I have researched this and I can't find anything "in writing". I am pretty confident in telling him he must follow the rules for global when following up with the patient when it's related to the surgery or reason for surgery (unless he is seeing the patient that is unrelated to the reason for surgery). Does anyone have anything I can use to share with this physician?

 

[amyjph]

Do you mean a scenario in which the group practice has a surgeon A using surgeon B as an assistant? Then, surgeon B sees the patient during the global period for a post operative visit and no other unrelated problems are addressed? Surgeon A, B or any other surgeon in the group can't bill for the global follow up.
Think of it like this for a total hip arthoplasty for example, if the CPT 27130 allows assistant-at-surgery to be billed and paid, Surgeon A & Surgeon B have billed a global CPT 27130 therefore, the patient is also global to them.
The same would be true if a PA was acting as an assistant and the patient followed up with the PA in the same group practice for global visits post op, they don't get to bill an E&M.
If surgeon B assisted surgeon A but was from another practice and was going to provide the follow up care only this would be a different scenario involving transfer of care and possibly 54/55 modifiers.

https://www.cms.gov/outreach-and-education/medicare-learning-network-mln/mlnproducts/downloads/globallsurgery-icn907166.pdf

https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c12.pdf 40 - Surgeons and Global Surgery (Rev. 1, 10-01-03) B3-4820
https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c12.pdf 30.6.5 - Physicians in Group Practice, 30.6.6 - Payment for Evaluation and Management Services Provided During Global Period of Surgery

Your Quick Guide to the Global Surgical Package

Make quick and easy work of determining which procedures and services are bundled and when. Most coders, billers, and clinicians are familiar with the The global surgical package includes all the necessary services normally furnished by a surgeon before, during, and after a procedure.

www.aapc.com

The global surgical package, also called global surgery, includes all the necessary services normally furnished by a surgeon before, during, and after a procedure. Medicare payment for a surgical procedure includes the pre-operative, intra-operative, and post-operative services routinely performed by the surgeon or by members of the same group with the same specialty.

There could be exceptions to this depending on if the provider was only providing surgical care but not post-operative care like (54/55 mod). There are some other exceptions. Teaching facility rules could be different too.

 

[kristina.l.bennett@osfhealthcare.org]

Yes that is the scenario. Thank you so much for this! It's very helpful and should satisfy my provider. Have a great day!