Wiki Surgery global period - established patient?

[mhaney]

My provider works for another group and performed surgery under that group billing number. If that patient then sees that same provider during the surgery global period but under a different group and billing number does that global period still apply or is the visit billable?

 

[thomas7331]

If the provider billed the global code, then the payment that was made for that surgery includes the post-operative care - it doesn't matter that they are seeing the patient in a different group. You should not bill for the post-operative care in that situation because you would be causing an overpayment.

If the providers wish to divide the intra-operative and post-operative care between the two practices, there's two ways they can do that: they can do a transfer of care after surgery and then bill the surgery with modifiers 54 and 55, respectively, so that the payer will reimburse each practice separately for each component. Or they can just handle it internally and work out how each of the two practice wishes to compensate the other and leave the payer out of the situation.

 

[csperoni]

Same provider (regardless of Tax ID/location) in the global period is included unless the specific services provided are not included in global (unrelated problem, etc).