|
< Back to the main Medical Review page
Global Surgery (GEN)
Posted May 5, 2008
In Pub. 100-04, Medicare Claims Processing Manual, Chapter 12, §40.1(D), attention is drawn to physicians furnishing less than the full global surgical package. If the surgeon performs a surgical procedure, but does not furnish the follow-up care, payment for the postoperative, post-discharge care is split with two or more physicians where the physicians agree on the transfer of care. Where a transfer of care does not occur, the services of another physician may either by paid separately or denied for medical necessity reasons, depending on the circumstances of the case.
Under §40.2(A)(3), where surgeons agree on the transfer of case during the global period, the following modifiers are used: 54 for surgical care only; or 55 for postoperative management only. The date on which the care was relinquished or assumed as applicable must be shown on the claim; this should be indicated in Item 19 of the CMS-1500 claim form or the electronic equivalent.
Where a transfer of postoperative care occurs, the receiving physician cannot bill for any part of the global services until he/she has provided at least one service. Once the physician has seen the patient, that physician may bill for the period beginning with the date on which he/she assumes care of the patient. Exceptions are described §40.2(A)(3).
Above are the highlights in relation to this matter. You are invited to review the global surgery section to find the variations which may be applicable to the varied situations and arrangements in which you may participate. Those who split the global surgery package should review the portions of §40 in relation to global surgery to become familiar with the aspects of the subject applicable to their services. Pub. 100-04, Medicare Claims Processing Manual, can be accessed at www.cms.hhs.gov/Manuals/IOM/list.asp on the Centers for Medicare & Medicaid Services (CMS) Web site. |
|
