Wiki post op period

[Korbc]

heyy

if a person gets diagnostic lapro done and they find endometriosis and have to come in for further visits regarding treatment for it, would this still be considered global and related to the original procedure or could unrelated and I could charge for it. I assume related and global.........

thanks!

 

[CBLENNIE]

It depends on the global period assigned to the CPT code billed for the diagnostic lap procedure. If you provide the CPT code it could be looked up to determine what if any the global period is for the specific procedure code.

 

[Korbc]

It depends on the global period assigned to the CPT code billed for the diagnostic lap procedure. If you provide the CPT code it could be looked up to determine what if any the global period is for the specific procedure code.

thanks! so it is 58662, she was seen within global post op period to further treat her new diagnosis of endometriosis that they found when they went in. while they were in the excised some of the endo

 

[CBLENNIE]

thanks! so it is 58662, she was seen within global post op period to further treat her new diagnosis of endometriosis that they found when they went in. while they were in the excised some of the endo

First 58662 is not a "diagnostic laparoscopy", the description is "Laparoscopy, surgical; with fulguration or excision of lesions of the ovary, pelvic viscera, or peritoneal surface by any method". If it was diagnostic only the notes for 58662 state that a diagnostic laparoscopy only the proper CPT is 49320. The diagnostic laparoscopy is included in the surgical laparoscopy billed with 58662. The allowance adjusted for the locality being Connecticut for 58662 is $761.34 and for 49320 it is $353.89, which obviously accounts for the significant increase in work that a surgical laparoscopy compared to the diagnostic laparoscopy.

What was her pre-op diagnosis, did they suspect she had endometriosis, if not what was the reason for the procedure? I would think that if the pre-op diagnosis was due to signs & symptoms that necessitated the diagnostic procedure.

What was her post-op diagnosis, particularly what was submitted to the insurance company on the claim for 58662? Did the procedure start out as diagnostic and become surgical due to the finding of endometriosis when they went in and examined the patient's anatomy?

What was her post-op diagnosis? Any follow visits related to endometriosis during the 90-day global period are likely included in the 58662 that the provider billed and reimbursed for. Unless of course there is more to the story that I don't know at this point...

 

[Korbc]

First 58662 is not a "diagnostic laparoscopy", the description is "Laparoscopy, surgical; with fulguration or excision of lesions of the ovary, pelvic viscera, or peritoneal surface by any method". If it was diagnostic only the notes for 58662 state that a diagnostic laparoscopy only the proper CPT is 49320. The diagnostic laparoscopy is included in the surgical laparoscopy billed with 58662. The allowance adjusted for the locality being Connecticut for 58662 is $761.34 and for 49320 it is $353.89, which obviously accounts for the significant increase in work that a surgical laparoscopy compared to the diagnostic laparoscopy.

What was her pre-op diagnosis, did they suspect she had endometriosis, if not what was the reason for the procedure? I would think that if the pre-op diagnosis was due to signs & symptoms that necessitated the diagnostic procedure.

What was her post-op diagnosis, particularly what was submitted to the insurance company on the claim for 58662? Did the procedure start out as diagnostic and become surgical due to the finding of endometriosis when they went in and examined the patient's anatomy?

What was her post-op diagnosis? Any follow visits related to endometriosis during the 90-day global period are likely included in the 58662 that the provider billed and reimbursed for. Unless of course there is more to the story that I don't know at this point...

Hey

Sorry i should have been more clear, it started at diagnostic lapro then it turned into 58662, that's what I meant when I said the endo was found when they went in but i should have been more clear, that was a vague statement. I'm aware of the difference between the two procedures. I'm writing this late at night so I don't have the pre op dx in front of me, I beleive it might have just been pelvic pain and then the post op dx with endometriosis. So my main question is when there is a new dx found in surgery that requires additional care is the care considered global or not...
Thanks

 

[CBLENNIE]

I think any follow up visits in the 90-day global period for the diagnosis of endometriosis should be included in the post-op global period for 58662. If you think of it in terms of a common scenario such as appendicitis, it might make it clearer that you would not charge for any follow up visits for the diagnosis of endometriosis.

A patient is seen in the ED for abdominal pain and the suspected diagnosis is acute appendicitis and it taken to the OR for an appendectomy. The definitive diagnosis is acute appendicitis and the appendix is removed. Any follow up visits for the diagnosis of acute appendicitis are considered as included in the global surgical package and not separately billable.

The diagnosis of acute appendicitis is new, but it was treated by way of removing the appendix and in your patient's case the diagnosis of endometriosis is new, but it was treated by performance of 58662.

Does this help make sense of whether or not you can bill for visits for treatment of the patient's newly diagnosed endometriosis? Hopefully it goes without saying that any diagnostic procedures or therapeutic procedures are generally going to be separately billable for this patient's endometriosis.

 

[Korbc]

I think any follow up visits in the 90-day global period for the diagnosis of endometriosis should be included in the post-op global period for 58662. If you think of it in terms of a common scenario such as appendicitis, it might make it clearer that you would not charge for any follow up visits for the diagnosis of endometriosis.

A patient is seen in the ED for abdominal pain and the suspected diagnosis is acute appendicitis and it taken to the OR for an appendectomy. The definitive diagnosis is acute appendicitis and the appendix is removed. Any follow up visits for the diagnosis of acute appendicitis are considered as included in the global surgical package and not separately billable.

The diagnosis of acute appendicitis is new, but it was treated by way of removing the appendix and in your patient's case the diagnosis of endometriosis is new, but it was treated by performance of 58662.

Does this help make sense of whether or not you can bill for visits for treatment of the patient's newly diagnosed endometriosis? Hopefully it goes without saying that any diagnostic procedures or therapeutic procedures are generally going to be separately billable for this patient's endometriosis.

thanks! that's what i was thinking to /leaning towards as well

 

[nielynco]

heyy

if a person gets diagnostic lapro done and they find endometriosis and have to come in for further visits regarding treatment for it, would this still be considered global and related to the original procedure or could unrelated and I could charge for it. I assume related and global.........

thanks!

A diagnostic laparoscopy (for which I assume you coded as 58660) has a 90 day global period. But that covers recovery from surgery, not further visits with regard to "where do we go from here." This is the same principle that applies to cancer surgery followed by chemo treatments. If during this global, she ends up going back to the ER to have the endometriosis removed, you would bill 58662 with a modifier that indicates whether it was planned or whether is was not planned. If he found endometriosis I would assume that one of the options would be further surgery so a modifier -58 would probably apply, but also possibly -78.

 

[Korbc]

A diagnostic laparoscopy (for which I assume you coded as 58660) has a 90 day global period. But that covers recovery from surgery, not further visits with regard to "where do we go from here." This is the same principle that applies to cancer surgery followed by chemo treatments. If during this global, she ends up going back to the ER to have the endometriosis removed, you would bill 58662 with a modifier that indicates whether it was planned or whether is was not planned. If he found endometriosis I would assume that one of the options would be further surgery so a modifier -58 would probably apply, but also possibly -78.

thanks! I was thinking more of the office visits related to the endo that was found. because i don't believe he was able to remove it all. the diag. lapro turned into 58662. so I'm guess that because that was found at time of surgery and treatment in surgery was done for it that the visit would be global, and then if they did any other surgery during global i would append the appropriate modifier