global periods

If I perform a procedure with a 10 day global, and have the patient followup at 14 days for a wound check (or drain removal, etc.), could I bill this visit as an established patient visit, or would I still consider it a follow-up visit (and hence not billable)? The main purpose of the visit would be to follow-up from the procedure. This may be obvious to the coders in the forum, but to us clinicians sometimes its not so obvious. Thanks.

10 day global charge

The first visit after the procedure on a 10 day global should be a post op follow up visit. The patient should have really been scheduled within the 10 day global for the first follow up visit. Because the patient wasn't, I would code that as a follow up visit for the first visit after surgery.

global periods

There isn't anything in the CMS manual that covers this situation, so what you'll get is opinion.

There are some physicians who routinely try to bill their follow ups a few days after the period ends, and that is a red flag for payers. It is easy for them to see the date of service, and to count the ten days and to find a pattern of E/M services just as the global period ends. That obviously is a problem, and doesn't pertain to your question.

If you have been seeing the patient during the ten day global period for their usual follow up, and there is a complication or reason to see the patient at day 14 and maybe again at day 20, those are billable visits. They are out of the global and meet the criteria of medical necessity.

The third situation is when you haven't seen the patient from day 1-10, and the only follow up occurs at day 11 or 12, because of the vagaries of the schedule. I would not recommend reporting those.

These are my opinions about the topic.

global periods

My situation is closer to the second description. Actually what happened in this case is that the patient was scheduled to see me back in 7 days. She cancelled, and made a new appointment later for day 14 or 15 (can't remember exactly). This is not a routine practice of mine...to schedule patients after the global. I didn't bill for this visit, but is there anything in the CMS manual that says a postop visit is a postop visit, no matter when it happens...If this is the case, then what's the point of having a global period? Thanks.

global periods

The manual isn't specific about what to do in the situation you describe. The section of the manual that deals with the global period is at:

http://www.cms.hhs.gov/manuals/iom/List.asp

Publication 100-04, Chapter 12, Section 40

global 10 day

CPT codes affected by global packaging have a global period, the time period included in the reimbursement for a specific procedure. Minor procedures, such as a skin biopsy or the application of a cast, have a zero-day global period. That means that all services or visits provided as part of the procedure on the same day of the procedure are included in the global package.
If the patient comes back the same day after a skin biopsy to have the biopsy site checked for example, the physician cannot bill for a separate visit. But if the patient comes in the day after the biopsy, the visit can be billed (0 global days).
If the procedure has a 10 day follow up it includes the post-op check visit, that's why the global is extended. Medicare will be looking for a pattern of scheduling post-op visits (10 days) beyond the 10 day global and would consider this abuse. Their systems will deny an E/M within the global, if related to procedure. Otherwise if the encounter is outside the global, the E/M will probably be paid. Having said that, the first post-op visit for wound check should be part of the 10 day global because that is the intent of the extended global days, and should not be separately billed, in my opinion.

Global Period

I think to "cover your assests"I would make an office policy that any first visit after a procedure in or out of global should be a post op visit. This would cover you if indeed the patient was having a complication that they do not realize they are having. Sometimes the money saved by not charging for that first post op visit out o global is money well spent. Especially if it is within a week after global. You could set a policy with a time frame limit after global also. Just a thought.