AR2728
Expert
I'd like some feeback on visits during the global period. I completely undertand and agree that if the patient has an issue unrelated to the procedure that is treated during the global period that an office visit for that unrealted issue shoud be billed. However, here is an example of what I am seeing for one of my general surgeons-on a regular basis:
A hernia repair is performed on an established patient (in months prior to this the patient was being treated for gastritis diverticulosis and had an EGD/Colonoscopy performed and follow up visit for this). The patient presents back to the office for his second follow up visit to colectomy. A partial suture removal is done the CC lists diverticulosis, hx colon polyps, gastritis, status post henia repair, morbid obesity, atelectasis .. The note goes into detail about presenting symptoms prior to surgery, hospital stay-atelectasis, and then mentions his hx of polyps, gastritis and diverticulosis current treatment and is stable.
Assessment and Plan states
1. postop follow up...postop restrictions and care
2. diverticulosis hx colon polyps continue regimen
3. gastritis stable
4.atelectasis during hospital stay resolved (which was mentioned at the first follow up visit as well)
My surgoen wants to bill a separate E&M. This is a frequent occurance. He addresses issues that have previously been treated or are resolved, such as atelectasis or gastritis-when the reason for the visit was for suture removal or surgery follow up. It is typical for him to continue to document these issues on every follow up visit during the global period-even though the previous visit stated the issue was resolved. I have noticed this as a trend, he feels it is necessary to address all past history/conditions and then wants to justify billing a level. I however, feel that just because he feels it is necessary to go into great detail and do a thorough review at EVERY global follow up visit, this does not justify billing an E&M. I suppose my stance is ...what the patient is truly presenting for and what needs to be addressed...had the patient NOT had surgery would he have requested them to come back in 2 weeks for gastritis/diverticulosis only (for example).
A hernia repair is performed on an established patient (in months prior to this the patient was being treated for gastritis diverticulosis and had an EGD/Colonoscopy performed and follow up visit for this). The patient presents back to the office for his second follow up visit to colectomy. A partial suture removal is done the CC lists diverticulosis, hx colon polyps, gastritis, status post henia repair, morbid obesity, atelectasis .. The note goes into detail about presenting symptoms prior to surgery, hospital stay-atelectasis, and then mentions his hx of polyps, gastritis and diverticulosis current treatment and is stable.
Assessment and Plan states
1. postop follow up...postop restrictions and care
2. diverticulosis hx colon polyps continue regimen
3. gastritis stable
4.atelectasis during hospital stay resolved (which was mentioned at the first follow up visit as well)
My surgoen wants to bill a separate E&M. This is a frequent occurance. He addresses issues that have previously been treated or are resolved, such as atelectasis or gastritis-when the reason for the visit was for suture removal or surgery follow up. It is typical for him to continue to document these issues on every follow up visit during the global period-even though the previous visit stated the issue was resolved. I have noticed this as a trend, he feels it is necessary to address all past history/conditions and then wants to justify billing a level. I however, feel that just because he feels it is necessary to go into great detail and do a thorough review at EVERY global follow up visit, this does not justify billing an E&M. I suppose my stance is ...what the patient is truly presenting for and what needs to be addressed...had the patient NOT had surgery would he have requested them to come back in 2 weeks for gastritis/diverticulosis only (for example).