Wiki Charging E/M during the global period

[Amandamcbride]

Question: I have a Neurosurgeon who performed a Arthrodesis on a patient with no insurance. He is wanting to charge subsequent hospital care for four days following her surgery. My impression is that it can't be charged because she's in her global period and that would be included in the surgical package. However, the Doctor thinks he can charge it because she is a self-pay patient. Help!

 

[mhstrauss]

Question: I have a Neurosurgeon who performed a Arthrodesis on a patient with no insurance. He is wanting to charge subsequent hospital care for four days following her surgery. My impression is that it can't be charged because she's in her global period and that would be included in the surgical package. However, the Doctor thinks he can charge it because she is a self-pay patient. Help!

The "global period" is a AMA/CPT guideline, not an insurance guideline. It would be completely unethical to charge a patient that doesn't have insurance for post-op care (I'm assuming these visits are post-op care, not an unrelated problem). I'll try to find some solid resources for you to present to your doc.

 

[Amandamcbride]

I feel the same way. This Doc is very difficult to deal with. I've shown him the CPT guidlines from the book. If you can find any other documentation I would love to see it! Thank you!

 

[mhstrauss]

I found this blurb in one article:

"Postoperative care definition variances
According to CPT, the surgical package includes “typical postoperative care” and the treatment of complications is not included in the surgical package."

from this site:

http://www.aaos.org/news/aaosnow/mar13/managing2.asp

But everything else I see is Medicare or commercial payer guidelines, not self-pay. The main resource should be the Surgery Guidelines in the CPT book, and possibly the RVU files that show how many day are included in the global period for each surgical CPT.

Sorry I couldn't help more!