Wiki Transfer of Care Questions

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skbrauss

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When billing Medicare for the co-management of post op care after cataract surgery, I have three transfer of care questions:

Example, cataract surgery for the right eye is done on March 1st, 2015. Co-management of post op global care is assumed on March 3, 2015 and is relinquished on May 30, 2015. The co-management physician (Optometrist) has the proper orders, diagnosis and documentation for the transfer and assumption of care as of March 3rd, 2015 from the surgeon and the patient.

1. The Patient delays the first post op office visit until April 15th, 2015. Do you bill the Post Op Co-managment 66984-55-RT to Medicare using March 3rd, 2015 as the assumption of care date or do you use the date the patient came in- April 15th, 2015?
2. Can you bill Medicare for the 66984-55-RT if the patient never shows up for any of the scheduled post op visits? The Co-Management doctor did not see the patient during that 90 day Global Billing period.
3. Is it correct that the Co-Management physician is still responsible for their care during that time (the patient was not seen during the post op period) ? thanks!
 
Co-managing 54-55 modifier guidance

Reference: Medicare Manual; REV 1, 10-01-03; B3-15011 and B3 4820-4831

1: If documentation transfers the responsibility but the patient delays being seen, the co-managing provider is responsible for the entire period. The co-managing provider cannot file a claim until he/she has seen the patient. The date of service is still the date of surgery on both claims and the assumed date is still the date in the transfer of care document and relinquish date in the 90th day of the global period.

2: It is not billable if the patient is a no-show forever.

3: Once the transfer happens, the co-managing physician is responsible. If the patient is seen after the global period ends, the co-managing provider can file for the global period. The guidance says the claim can't be filed until the patient is seen the first time.

The OIG has directed CMS to discontinue designating global periods due to their review of ophthalmology/optometry records that indicate that follow-up care is not being performed as written in the original guidance.
 
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