ortholg@yahoo.com
Guest
Hello. We're an Ortho GROUP (all providers billing under one Tax ID) in upstate NY who since the beginning of April, have been getting denials for fracture charges submitted by our midlevel practitioners (PA and NP). We called Medicare and spoke to several reps in the claims dept. and they're all telling me that MCR has reviewed their policies and they've recently determined that they shouldn't have been, nor will they in the future, continue to pay for a midlevel practitioner billing any "major surgical" code. They tell me they are defining "major surgical codes" as "any code with a 90 day global period".
So then my question is in regard to this scenario: A patient comes into our practice and is treated by a midlevel for a fracture and a temporary splint is applied. Then 3 days later the Physician sees the patient again, re-evaluates and treats the fracture in a more permanent capacity.
Would there be any problem with midlevel diagnosing the fracture and charging the office visit as well as the splint application and materials AND THEN the Physician charging a re-eval and the appropriate fracture treatment code a few days later?
So then my question is in regard to this scenario: A patient comes into our practice and is treated by a midlevel for a fracture and a temporary splint is applied. Then 3 days later the Physician sees the patient again, re-evaluates and treats the fracture in a more permanent capacity.
Would there be any problem with midlevel diagnosing the fracture and charging the office visit as well as the splint application and materials AND THEN the Physician charging a re-eval and the appropriate fracture treatment code a few days later?