Orthopedic Coding: Global Starts Post-procedure

By Author: erinarticle
Total Articles: 106
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Recently, an established patient with degenerative scoliosis reported to the orthopedist for an evaluation/management visit. Notes pointed out that it was a preoperative visit to prepare the patient for cervical laminoplasty surgery (the service took place 48 hours prior to the surgery). Encounter notes also indicated a level three evaluation/management service. Is this evaluation/management part of the global period for the laminoplasty?


Well, it depends on the insurer. Some will not allow you to bill for this visit, whereas others will. If the carrier does cover the preoperative visit, go for the following:


99213 for the evaluation & management


737.30 added to 99213 to signify the patient's condition.


Clarification: If the carrier pays for this pre-op visit, the 90-day global period for 63050 starts on the day after the procedure. Any service the doctor provides pre-procedure is not dictated by global rules.


As such if the orthopedist carries out the laminoplasty on March 1, and the patient reports for a follow-up visit ...
... two weeks later so that the orthopedist can check on his condition, the evaluation/management would be bundled into the global package.


There are exceptions: If the patient reports to the orthopedist during the global period for a problem not related to the surgery, you might be able to report the visit. For instance, let us say the patient had cervical laminoplasty surgery on February 11. On March 4, the patient reports to the orthopedist with complaints of neck pain and frequent headaches. Notes point to the fact that NPP carried out an expanded problem focused history and exam.


In this example, you might be able to report 99213 with 784.0 added to represent the patient's symptoms. If you code for an unrelated Evaluation/management during a surgical global period, see to it that the patient's problem is not connected to the earlier surgery.


For more on this and for other specialty-specific articles to assist your orthopedic coding, sign up for a good medical coding resource like Coding Institute.