Global Period 2 Part Question

Scenario - You have an LLC comprised of primary care and specialty providers who bill under one TAX ID number. All insurance payments are made out to the LLC, not to the individual providers, i.e., the providers reassign the benefits to the LLC.

question 1 - Patient undergoes surgery. While in the postoperative global period, the patient sees his primary care for an unrelated problem. Does the visit with the PCP require a modifier 24?

question 2 - Decision for left meniscectomy is made today for a surgery to take place mid December. Prior to the surgery, the patient sees his primary care for left knee pain. Is the visit with the PCP billable or is it part of the global period?

global

primary does not use modifier, he did not do surgery nor is he same specialty.
Left knee pain is separately billed, not a pre-op visit.

Global period 2 part question

The PCP does not need modifier 24 even though the PCP is part of the same group as the surgeon.

The PCP may still be paid for the knee pain, without a modifier.

The global surgery rules are specialty specific.

If the second situation happened all the time, one might ask about the medical necessity of seeing the PCP instead of Ortho, but from time to time, I don't see an issue.

Global Period Revisited

Bear in mind that our primary care and specialists are all within one group practice/LLC, i.e. checks are addressed to the group/LLC not the provider.

We were told in an audioconference presented by Margie Vaught last week that those affected by the global period are:
the surgeon
the surgeon's partners
the surgeon's partners of different specialties in the same group practice

She indicated that different specialties relates to E/M services. Per CMS, it is different for surgical procedures.

In regard to "Group Practices" she stated the following:
One needs to know if the provider reassigned benefits to the group (generally a check is made out to the group name). This means if the general surgeon does the procedure and the patient returns in ten days to see his primary care for postop check, this is not a billable service as the "group" is within the global period.

Global period revisited

Do you have a citation for this? I'd like to see it.