Wiki Global Period for Gastric Endoscopy

[zathras1974]

Hello everyone, just a billing question that I hope I might be able to get some assistance with.

First, let me preface by saying I am still a student in a MBC program, so please bear with me if the question might seem a little elementary.

In February my mother went in for gastric endoscopy to diagnose a hiatal hernia. About 4 hours after being released from the ASC, she spiked a 104 fever. This necessitated a visit to the ER, diagnosis of aspiration pneumonia, and subsequent overnight admission.

During the ER visit we advised the billing representative that we felt we had a global period situation. So when the hospital attempted to bill for the visit and admission, I advised against payment, due to this being a direct complication from the procedure. I feel all care received in the ER and hospital admission should fall under the global period for the endoscopy.

As an aside, the hospital is refusing to release to us the ICD and CPT codes they billed medicare, saying "only insurance companies are entitled to that information". Thus I can't be sure of the procedure codes they used.

What I'm hoping for is some direction toward a website that specifies:
a) What the global period for a gastric endoscopy is (I believe it's 0 day, but that's only a guess).
b) A global package covers complications resulting from a procedure.

The hospital is refusing to acknowledge that a global period even exists for an endoscopy.

We are located in Florida, if that makes a difference.

ANY help would be very much appreciated.

~Stephen

 

[mhstrauss]

Hello everyone, just a billing question that I hope I might be able to get some assistance with.

First, let me preface by saying I am still a student in a MBC program, so please bear with me if the question might seem a little elementary.

In February my mother went in for gastric endoscopy to diagnose a hiatal hernia. About 4 hours after being released from the ASC, she spiked a 104 fever. This necessitated a visit to the ER, diagnosis of aspiration pneumonia, and subsequent overnight admission.

During the ER visit we advised the billing representative that we felt we had a global period situation. So when the hospital attempted to bill for the visit and admission, I advised against payment, due to this being a direct complication from the procedure. I feel all care received in the ER and hospital admission should fall under the global period for the endoscopy.

As an aside, the hospital is refusing to release to us the ICD and CPT codes they billed medicare, saying "only insurance companies are entitled to that information". Thus I can't be sure of the procedure codes they used.

What I'm hoping for is some direction toward a website that specifies:
a) What the global period for a gastric endoscopy is (I believe it's 0 day, but that's only a guess).
b) A global package covers complications resulting from a procedure.

The hospital is refusing to acknowledge that a global period even exists for an endoscopy.

We are located in Florida, if that makes a difference.

ANY help would be very much appreciated.

~Stephen

Here's a good (but unfortunate) way to get familiar with the resources available.

You can find info on global days in CMS's RVU files located here:

http://www.cms.gov/Medicare/Medicar...ysicianFeeSched/PFS-Relative-Value-Files.html

Click on the 2015 Files--it will be a huge spreadsheet. Find the endoscopy code, and Global days are in Column O.


The Global Fact Sheet is here:

http://www.cms.gov/Outreach-and-Edu...oducts/downloads/GloballSurgery-ICN907166.pdf


Ok, so you didn't mention if her insurance is Medicare vs commercial, so there may be differences in what exactly is included in the global period, when it comes to complications. Medicare will not pay for complications UNLESS it results in a return to the OR. Commercial payers might, depending on whether or not they follow Medicare guidelines. The global period only applies to the provider that performed the procedure that the original service was billed by, so if she was seen by other doctors in the ER, no, the "global period" (if there is one) won't apply. It does not apply to facilities either. Just a guess on my part, but I would imagine she was seen by an ER doc, not the same gastro that did the scope.

Hope that helps some!

 

[thomas7331]

You're correct that the global period of endoscopies is usually zero days. However, as the previous poster mentions. the global period does not apply to the facility - it's exclusively a CPT/professional coding concept. Facility claims are governed by much different rules. If the ASC is owned by the hospital, then under Medicare rules, the facility charges of the ASC would be usually be considered part of the inpatient claim and not paid separately (most charges incurred during the 72-hour period prior to admission are part of the DRG under which the facility is paid). But if this is a commercial insurance claim, then the contractual guidelines could be different.