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Wiki Global Period with Different Provider/Same Practice

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dballard2004

dballard2004

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I am auditing a chart and this issue has come up. For this clinic, we have two providers. Dr. A and Dr. B. A patient came in to see Dr. A for a skin tag removal. I am aware that there is a 0-10 day global period attached to this procedure. My question is, the patient came in for follow-up three days after the procedure, but they saw Dr. B instead. The providers are questioning this. Does the global still apply to Dr. B since he did not do the surgery? I say yes, but he coded this with a regular E/M and is questioning why it would be 99024 (my detemination). Can anyone help me clearly explain this? Thanks.
 
First, does Dr. B have a subspecialty? Did Dr. B see this pt for the Tag Removal follow-up? If Dr. B has a subspecialty and did NOT see the pt for the Tag Removal, then you can bill an E&M. If he has the same specialty and the pt was seen for the tag removal F/U, then it is 99024.
 
There is no subspecialty. Both are primary care providers and the follow-up was for the tag removal. I too thought that the global would still apply since this is the same specialty, but Dr. B states that the global period excludes services provided by other providers so the global does not apply to him. I disagree and think 99024 is appropriate. Thanks Ray and Colleen for your help.
 
I agree, CMS sees providers of the same specialty in the same group as the same person, this would be global.

Laura, CPC, CEMC
 
I was reviewing your question, and you want to keep in mind that if the patient came back for just the follow-up, then yes it will be global, but if the patient has a complication, ex: reaction to prescription, then use a modifier 24 on the E/M and it will get paid. Just make sure that it has a different diag than the initial procedural visit. ex: complication code...
 
krssy70 said:
I was reviewing your question, and you want to keep in mind that if the patient came back for just the follow-up, then yes it will be global, but if the patient has a complication, ex: reaction to prescription, then use a modifier 24 on the E/M and it will get paid. Just make sure that it has a different diag than the initial procedural visit. ex: complication code...
Click to expand...

Not for Medicare...(complication)

Many carriers follow CMS's global policy...you would need to check your payer to see if the follow CMS' global policy or CPT's
 
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