Wiki Charging E&M outside of global period, related to surgical procedure

[Cassid2]

I am looking for documentation to give my providers regarding why they should charge E&M outside of global, even if the visit is related to the surgical procedure. They are aware of what is included in the global package, but they choose to not charge some patients outside of global, but are charging others. This also pertains to, for example, scar revision, or injection into a scar, outside of global. They will sometimes charge, sometimes discount. Any help is appreciated.

Thank you,
Michelle Waller, CPC

 

[csperoni]

CMS rules vs AMA rules

Basically, the situation relates to the insurance.
If the patient has Medicare, you must follow the CMS rules which means even extensive complications related to the surgery are all included, unless you return to the OR for another procedure.
If the patient does not have Medicare, you should check whether or not the carrier follows CMS rules. If so, the above applies - related visits NOT billable. If the carrier does not follow CMS rules, you may choose to follow the AMA guidlelines which is that complications (with an additional diagnosis) are billable.
This was a very good article on the AAPC website explaining it in detail:
https://www.aapc.com/blog/41165-post-operative-complications-global-period/
There are many offices (particularly large healthcare systems from my experience) that will follow the CMS rules regardless of the carrier.