Wiki Post OP & Surgical care- Same TAX ID

[JC052382]

I've been asked to research if our Optometrist is able to bill for the POST OP care on a patient after cataract surgery under the same Tax Id as the Surgeon. Our Ophthalmologist is performing the surgery and would bill the surgical care (54 modifier) and our Optometrist would bill for the Post OP care (modifier 55). They are both under the same tax ID. Does anyone know if this is allowed since they would be billed under the same tax ID? If so, does anyone have something in writing?

Thanks in advance!

 

[Cheezum51]

Other than for internal tracking purposes for income generation, why would you want to break down the surgery care and post-op care since verything is billed under the same Tax ID?

Tom Cheezum, O.D., CPC, COPC

 

[lucidomary]

Global Surgical Package

No, you may not. Per CMS:

https://www.cms.gov/Outreach-and-Ed...oducts/downloads/GloballSurgery-ICN907166.pdf

The global surgical package, also called global surgery, includes all the necessary services normally furnished by a surgeon before, during, and after a procedure. Medicare payment for a surgical procedure includes the pre-operative, intra-operative, and post-operative services routinely performed by the surgeon or by members of the same group with the same specialty. Physicians in the same group practice who are in the same specialty must bill and be paid as though they were a single physician. For more information, refer to the “Medicare Claims Processing Manual”, Chapter 12, Sections 40 and 40.1.

 

[thomas7331]

No, you may not. Per CMS:

https://www.cms.gov/Outreach-and-Ed...oducts/downloads/GloballSurgery-ICN907166.pdf

The global surgical package, also called global surgery, includes all the necessary services normally furnished by a surgeon before, during, and after a procedure. Medicare payment for a surgical procedure includes the pre-operative, intra-operative, and post-operative services routinely performed by the surgeon or by members of the same group with the same specialty. Physicians in the same group practice who are in the same specialty must bill and be paid as though they were a single physician. For more information, refer to the “Medicare Claims Processing Manual”, Chapter 12, Sections 40 and 40.1.

This information does not apply in this situation - Medicare recognizes optometry as a separate specialty, so in this case the two physicians would not be of the same specialty.

 

[Cheezum51]

Thomas, I understand what you're saying regarding the different specialties. However, since the surgeon and the optometrist are in the same group and under the same TID#, what difference does it make? Several of the larger surgical groups in our area have the group optometrist do the post op care but bill the surgery without any 54 or 55 modifiers because various providers, of either specialty, may be involved in the various post op visits.

If the optometrist was in a different practice and was co-managing the post op care with the surgeon, then the appropriate 54 and 55 modifiers would be used by the providers involved.

Tom Cheezum, O.D., CPC, COPC

 

[thomas7331]

Thomas, I understand what you're saying regarding the different specialties. However, since the surgeon and the optometrist are in the same group and under the same TID#, what difference does it make? Several of the larger surgical groups in our area have the group optometrist do the post op care but bill the surgery without any 54 or 55 modifiers because various providers, of either specialty, may be involved in the various post op visits.

If the optometrist was in a different practice and was co-managing the post op care with the surgeon, then the appropriate 54 and 55 modifiers would be used by the providers involved.

Tom Cheezum, O.D., CPC, COPC

I agree with you that billing the surgical package globally or split would make no financial difference if both providers are under the same tax ID. My post was intended just to respond to the previous one which I believe incorrectly cited the CMS global surgery rules stating that splitting the surgical and post-op care would be prohibited - that rule only applies to physicians within the group of the same specialty. If a practice wanted to bill the intra-operative and post-operative care between providers of different specialties, I'm not aware of any guidance stating that they could not do this. But I agree that there would be no real gain in doing this, and indeed it would likely create additional administrative costs for the practice in managing two sets of claims instead of one.