Wiki Intraoperative repairs

[phycoder]

Ok, I have this question as I've never come across this scenario before. I know that inraoperative accidental repairs are not billable BUT I have a prov who is of one specialty that lacerated the liver and had to call a physician of another specialty to come and repair it. Is that repair billable? If so how and where can I find written rules (I forgot which specialties as I don't have access the chart at this very moment. Any help is appreciated

 

[daniel]

Hi, yes it's billable in this specific context. key is it's a different specialist, we have alot of urology docs repair the bladder or place stents during a intraop setting for TRAUMA/GEN Surgery or even GYN-Uro.

Hope this helps

 

[phycoder]

Hi, yes it's billable in this specific context. key is it's a different specialist, we have alot of urology docs repair the bladder or place stents during a intraop setting for TRAUMA/GEN Surgery or even GYN-Uro.

Hope this helps

is there anyplace I can get in writing so that I can dispel the arguments on it?

 

[daniel]

Hi- I don't think you'll find a official guidance on this, your teams thinking is correct. But the rule of incidental repair (intra-op) or placement of intra-op stent 52005 is for the same surgeon (specialist). So when a surgeon, say Trauma does a 44140 procedure, then nicks the bladder and calls in a urologist. The urologist can and will code 51860/51865, since he/she is not the one who created this incident. If the Trauma doc repaired it, then yes. It's inclusive.

One conversation point, would be kind of hard to stand on telling the different specialist doc he can't code his procedure base on the rule their referencing. It's pretty clear the rule is for same specialist.

 

[phycoder]

Hi- I don't think you'll find a official guidance on this, your teams thinking is correct. But the rule of incidental repair (intra-op) or placement of intra-op stent 52005 is for the same surgeon (specialist). So when a surgeon, say Trauma does a 44140 procedure, then nicks the bladder and calls in a urologist. The urologist can and will code 51860/51865, since he/she is not the one who created this incident. If the Trauma doc repaired it, then yes. It's inclusive.

One conversation point, would be kind of hard to stand on telling the different specialist doc he can't code his procedure base on the rule their referencing. It's pretty clear the rule is for same specialist.

Thank you so much for your help. This helps a lot

 

[csperoni]

The Medicare Global surgery booklet states:
The global surgical package, also called global surgery, includes all necessary services normally provided by a physician (or members of the same group with the same specialty) before, during, and after a procedure. Medicare physicians in the same group practice, with the same specialty, must bill and accept payment as though they’re a single physician.

So, while this doesn't say "If your doctor didn't do the initial surgery, your doctor can bill for the injury repair", it can be inferred if you are trying to find some type of reference.

 

[phycoder]

The Medicare Global surgery booklet states:
The global surgical package, also called global surgery, includes all necessary services normally provided by a physician (or members of the same group with the same specialty) before, during, and after a procedure. Medicare physicians in the same group practice, with the same specialty, must bill and accept payment as though they’re a single physician.

So, while this doesn't say "If your doctor didn't do the initial surgery, your doctor can bill for the injury repair", it can be inferred if you are trying to find some type of reference.

thank you very much