How Do I Bill For Follow-Up Visits After the Global?

Tip: Make sure the ICD-9 coding & documentation support follow-up visits after the global. Question: Code 19101 has a 10-day global period, which means you cannot bill an E/M for anything related to that procedure within that time frame. If the patient continues to have follow-up visits outside the global period, should we then report the [...] Related articles:

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Tip: Make sure the ICD-9 coding & documentation support follow-up visits after the global.

Question: Code 19101 has a 10-day global period, which means you cannot bill an E/M for anything related to that procedure within that time frame. If the patient continues to have follow-up visits outside the global period, should we then report the appropriate E/M level?

Example: Patient has an open breast biopsy on June 15, so the global period goes through June 25. The patient then has additional follow-up visits on June 26, July 3, and July 10. What is the most appropriate way to bill for the three follow-up visits that the surgeon provides outside the global period? Does modifier 24 apply?

Answer …

Answer: You are correct that 19101 (Biopsy of breast; open, incisional) has a 10-day global period. You should code each of the medically necessary office visits (99212-99215, Office or other outpatient visit for the evaluation and management of an established patient …) that the surgeon provides outside the 10-day global period. You do not need to append a modifier.

You do need a modifier, however, when you have a patient visit during the global period that is separate and distinct from the expected post-procedural follow-up.

Then you should use modifier 24 (Unrelated evaluation and management service by the same physician during a postoperative period).

Be prepared for the insurer to question why so many additional post-procedural visits are necessary. Make sure that the ICD-9 coding reflects any complications, such as infection (998.59, Other postoperative infection), that explain the unusual volume of follow-up visits.

Caution: Before billing the first non-included E/M service on June 26, make sure that extenuating circum-stances did not push the visit into a billable period. For instance, was the 25th a Sunday and you didn’t have any office hours until the 26th? Or did your office have no visits available on the 25th or before, so the patient was forced to come in after the global period ended? If scheduling gamed the system, you should include the visit on the 26th in the global period for 19101.

You can separately bill the appropriate E/M level for the visits on July 3 and July 10.

If you don’t want federal auditors to come knocking, it’s more important than ever not to code and bill services separately if they should be in the global period. But an overly cautious approach could hurt your bottom line. Learn the rules and get all the reimbursement you deserve at this audio conference.