Bernadette10
Guru
Can this followup clinic visit after surgery (ESWL with 90 day global) by the same provider be billed as 99213-24, or is it all part of routine postop care 99024? The provider gave the patient education on ways to prevent kidney stones, so would this be considered treatment of the original condition?
HPI: The patient presents postop from his RT ESWL treatment 1 month ago. He had some RT-sided complaints after his KUB showed possible stone fragment at the RT UVJ, and brings with him a stone fragment which he subsequently passed. His pain has now completely resolved.
Assessment and Plan:
Nephrolithiasis, improved. Stone to be sent for analysis today. We will refer him to a new PCP and send off a PSA level as well for routine screening. Stone counseling advice as noted below.
Stone prevention advice:
He understands his diagnosis of kidney stones. We discussed that the exact origin of stones remains unclear but that there are several risk factors for stone development. He understands that adequate hydration is critical for preventing future stone formation and that the best way to determine they are hydrated is to ensure his urine is clear. Targeted urine output daily is 2500mL. Generally adding citrus to the water with lemon or lime is beneficial. Sometimes additional citrate measures can help as well, such as consumption of the over the counter "Moonstone" drink. Additionally, he has been encouraged to limit sodium intake as this has been associated with increased calcium in the urine. He also understands that limiting animal protein has been shown to be helpful in stone prevention.
I discussed with him that unfortunately despite all of our efforts, kidney stones tend to be a chronic disease with intermittent exacerbations due to large stones or obstruction. We discussed that his risk of recurrent stones is approximately 50% in the next 5 years and approximately 80% in the next decade. This can be improved somewhat if they are able to follow the dietary regimen and we can discuss initiation of medical therapy after they have had their stone burden cleared.
Your Quick Guide to the Global Surgical Package - AAPC Knowledge Center
What’s Not Included in the Global Surgical Package?
Medical procedures or services unrelated to the global surgery aren’t included in the global package and may be reported (and reimbursed) separately.
Per CMS, the following services are not included in the global surgical payment. These services may be billed and paid for separately:
Initial consultation or evaluation of the problem by the surgeon to determine the need for major surgeries. This is billed separately using the modifier 57 (Decision for Surgery). This visit may be billed separately only for major surgical procedures.
Services of other physicians related to the surgery, except where the surgeon and the other physician(s) 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.
Visits unrelated to the diagnosis for which the surgical procedure is performed, unless the visits occur due to complications of the surgery
Treatment for the underlying condition or an added course of treatment which is not part of normal recovery from surgery
Diagnostic tests and procedures, including diagnostic radiological procedures
Clearly distinct surgical procedures that occur during the post-operative period which are not re-operations or treatment for complications
Treatment for post-operative complications requiring a return trip to the Operating Room (OR). An OR, for this purpose, is defined as a place of service specifically equipped and staffed for the sole purpose of performing procedures. The term includes a cardiac catheterization suite, a laser suite, and an endoscopy suite. It does not include a patient’s room, a minor treatment room, a recovery room, or an intensive care unit (unless the patient’s condition was so critical there would be insufficient time for transportation to an OR).
If a less extensive procedure fails, and a more extensive procedure is required, the second procedure is payable separately.
Immunosuppressive therapy for organ transplants
Critical care services (CPT codes 99291 and 99292) unrelated to the surgery where a seriously injured or burned patient is critically ill and requires constant attendance of the physician
HPI: The patient presents postop from his RT ESWL treatment 1 month ago. He had some RT-sided complaints after his KUB showed possible stone fragment at the RT UVJ, and brings with him a stone fragment which he subsequently passed. His pain has now completely resolved.
Assessment and Plan:
Nephrolithiasis, improved. Stone to be sent for analysis today. We will refer him to a new PCP and send off a PSA level as well for routine screening. Stone counseling advice as noted below.
Stone prevention advice:
He understands his diagnosis of kidney stones. We discussed that the exact origin of stones remains unclear but that there are several risk factors for stone development. He understands that adequate hydration is critical for preventing future stone formation and that the best way to determine they are hydrated is to ensure his urine is clear. Targeted urine output daily is 2500mL. Generally adding citrus to the water with lemon or lime is beneficial. Sometimes additional citrate measures can help as well, such as consumption of the over the counter "Moonstone" drink. Additionally, he has been encouraged to limit sodium intake as this has been associated with increased calcium in the urine. He also understands that limiting animal protein has been shown to be helpful in stone prevention.
I discussed with him that unfortunately despite all of our efforts, kidney stones tend to be a chronic disease with intermittent exacerbations due to large stones or obstruction. We discussed that his risk of recurrent stones is approximately 50% in the next 5 years and approximately 80% in the next decade. This can be improved somewhat if they are able to follow the dietary regimen and we can discuss initiation of medical therapy after they have had their stone burden cleared.
Your Quick Guide to the Global Surgical Package - AAPC Knowledge Center
What’s Not Included in the Global Surgical Package?
Medical procedures or services unrelated to the global surgery aren’t included in the global package and may be reported (and reimbursed) separately.
Per CMS, the following services are not included in the global surgical payment. These services may be billed and paid for separately:
Initial consultation or evaluation of the problem by the surgeon to determine the need for major surgeries. This is billed separately using the modifier 57 (Decision for Surgery). This visit may be billed separately only for major surgical procedures.
Services of other physicians related to the surgery, except where the surgeon and the other physician(s) 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.
Visits unrelated to the diagnosis for which the surgical procedure is performed, unless the visits occur due to complications of the surgery
Treatment for the underlying condition or an added course of treatment which is not part of normal recovery from surgery
Diagnostic tests and procedures, including diagnostic radiological procedures
Clearly distinct surgical procedures that occur during the post-operative period which are not re-operations or treatment for complications
Treatment for post-operative complications requiring a return trip to the Operating Room (OR). An OR, for this purpose, is defined as a place of service specifically equipped and staffed for the sole purpose of performing procedures. The term includes a cardiac catheterization suite, a laser suite, and an endoscopy suite. It does not include a patient’s room, a minor treatment room, a recovery room, or an intensive care unit (unless the patient’s condition was so critical there would be insufficient time for transportation to an OR).
If a less extensive procedure fails, and a more extensive procedure is required, the second procedure is payable separately.
Immunosuppressive therapy for organ transplants
Critical care services (CPT codes 99291 and 99292) unrelated to the surgery where a seriously injured or burned patient is critically ill and requires constant attendance of the physician