Wiki ER Doc and Ortho Doc Fx Care

[kristinab]

I have an issue that has just come up that I need some advice on. There was a patient seen in the ER and diagnosed with a fracture. The patient was splinted and referred on to the ortho for care. The ER doc charged a fx care and now our claims our being denied stating that the patient is in a global period. Is that correct?

 

[kathydaniel]

Since your doc isn't the one that performed the fx care, he would not be held to the global period.

From the CMS manual:

Services NOT included in the global surgical package

Services of OTHER physicians except when the surgeon and the other physician agree on the transfer of care. This agreement may be in the form of a letter or an annotation in the discharge summary, hospital record or ASC record.

You may have a problem if the discharge papers state that he is transferring the care to your office. Then the hospital should have added a mod -54-56 and your office would have added a mod -55 to the initial visit.

Hope this helps!