Wiki Why is the code G0559 not the appropriate procedural code for OPD7202?

[MLoadman]

Since the provider for the follow-up visit is different from the surgeon noted in the follow-up note, why is G0559 not appropriate but 99212 is the more appropriate code?

[INDEX] MEDICAL RECORD [INDEX]
FOLLOW- UP VISIT

DATE: 11/21/20xx

Sex: F AGE: 20

HPI: This patient presents today for 2 weeks recheck of Nexplanon. Her Nexplanon was placed on 12/19/12 without complications per Dr. Huebert. She reports doing well with it. She denies pain at insertion site, no signs or symptoms of infection. She has been afebrile. She has had no vaginal bleeding. She offers no complaints today.
Vitals: Wt.: 162 BP: 108/76
Allergies: NKDA
Meds: None
LMP: 12/5/12

ASSESSMENT: Gen: WDWN, presents in no acute distress. The inner side of upper left arm was palpated and the Nexplanon rod was noted to be located at its original insertion site. No ecchymosis, no edema, no erythema, no s & s of infection. Neg. TTP.

PLAN: Nexplanon recheck, doing well. She is to RTC in 1 year, otherwise sooner if needed.

Signed Dr. Kramer

 

[csperoni]

G0559 is a new code and has several requirements to it's use. Consider the following:
1) Are Dr. Huebert & Dr. Kramer part of the same group?
2) Does the prior procedure have a 90 day global period?
3) If yes, was there a formal transfer of care?
4) G0559 is intended to use in addition to an E&M code for the additional work/complexity involved in the scenarios described in the code.

G0559 is also a code flagged as carrier judgement code which could mean some carriers do not even acknowledge this code.