jdibble
True Blue
We have been requested to refund an overpayment for one of our docs from a RAC review for a visit from 2008 and the doc doesn't think that he billed incorrectly. Can someone explain why we should not have billed for the following scenario or if we were correct in billing? 
The patient presented on 05/6/08 for a consult to place a port-a-cath. The doctor decided at this visit that the patient would be a canidate for the surgery, however due to an exisiting open wound at her mastectomy site, it was decided that surgery would need to be postponed until the wound was completely healed to avoid an infection to the port site.
The patient returned 05/12/08 for the doctor to see how the wound was healing. At this visit, he felt the wound was still not healed enough and had patient return on 05/16/08 again. The patient was asked again to return on 05/21/08 for further assessment. At this last visit, the doctor felt the wound had healed enough and scheduled the patient for surgery on 05/30/08. The procedure for the port-a-cath, 36561 was billed and has a 10 day global - which is a minor surgery.
When I reviewed the Medicare website, it states that the global period starts the day of the procedure for a minor procedure. I could not find any statments about what is billable or not billable as far as E/M visits pre-op. I have tried to research this on this forum, but I am still confused as to why they are denying the 05/06 visit (when they have not denied the other visits).
I appreciate any help in this issue - and also a source for documentation to support your thoughts as I could use this in the appeal the doctor wishes to pursue.
Thanks,
The patient presented on 05/6/08 for a consult to place a port-a-cath. The doctor decided at this visit that the patient would be a canidate for the surgery, however due to an exisiting open wound at her mastectomy site, it was decided that surgery would need to be postponed until the wound was completely healed to avoid an infection to the port site.
The patient returned 05/12/08 for the doctor to see how the wound was healing. At this visit, he felt the wound was still not healed enough and had patient return on 05/16/08 again. The patient was asked again to return on 05/21/08 for further assessment. At this last visit, the doctor felt the wound had healed enough and scheduled the patient for surgery on 05/30/08. The procedure for the port-a-cath, 36561 was billed and has a 10 day global - which is a minor surgery.
When I reviewed the Medicare website, it states that the global period starts the day of the procedure for a minor procedure. I could not find any statments about what is billable or not billable as far as E/M visits pre-op. I have tried to research this on this forum, but I am still confused as to why they are denying the 05/06 visit (when they have not denied the other visits).
I appreciate any help in this issue - and also a source for documentation to support your thoughts as I could use this in the appeal the doctor wishes to pursue.
Thanks,