Wiki Visit prior to surgery to go over pre and post-op meds.

[ddicrosta]

Please help to settle this ongoing discussion in my office. Patients come in for consultation with a PA for DJD hip or knee and decide they believe they are ready for surgery and a date is picked and appointments made. They come back to see the doctor who deems them a surgical candidate and arrangements move forward. They are given prescriptions for preop and postop meds. Shortly after some get confused on what to take and when. To alleviate the confusion, the docs want them to come back closer to surgery to go over them again. All three coders have told the docs they cannot bill for that as the decision for surgery has already been made and scheduled with no new problem or complication. Your thoughts on the matter will be appreciated. Thank you.

 

[csperoni]

Here is what is and is not included in the global surgical package per CMS Global Surgery Booklet:
What services does Medicare include in the global surgery payment?
We include these services in the global surgery payment when added to surgery:
● Pre-operative visits after the decision to operate. For major procedures, this includes pre-operative
visits the day before the surgery. For minor procedures, this includes pre-operative visits on the
surgery day.
● Intra-operative services, normally a necessary part of a surgical procedure.
● All other medical or surgical services the surgeon provides during the post-operative period
because the complications don’t require more trips to the operating room.
● Follow-up post-operative recovery period visits.
● Post-surgical patient pain management.
● Supplies (except exclusions).
● Miscellaneous services, like dressing changes, local incision care, operative pack removal, cutaneous
sutures and staples removal, lines, wires, tubes, drains, casts, and splints; insertion, irrigation, and
urinary catheter removal, routine peripheral intravenous lines, nasogastric and rectal tubes; and
tracheostomy tube changes and removals

The first bullet states additional visits after the decision to operate are included. Once the provider already determined the treatment, another visit to re-enforce or remind the patient about the surgery should not be separately billed. I would only bill a visit if when the patient comes in, the planned surgery is changed.

 

[NRaizman]

The Decision Regarding Surgery is not something that is well defined. A -provisional- decision regarding surgery, pending evaluation of medical status, labs, etc, is a decision regarding surgery for the purposes of E&M, but does not automatically put you into the global period. Similarly a decision to defer surgery when it is indicated, is also a Decision Regarding Surgery for the purposes of E&M.

This isa gray area, to some extent. Visits 1-3 days before surgery to do the pre-op H&P are clearly not billable visits.

However, if one makes a provisonal decision regarding surgery, a subsequent visit to evaluate consultations and labs and confirm that the patient is truly indicated for surgery is reasonable and may be billed. This is largely a matter of documentation.

In the case you describe, if the patient is being brought back to discuss post-op management, that's clearly part of the global service and cannot be billed and reimbursed separately. If the documentation reflects more of the above service, then it may be billable.