BC Advantage - 2012 Issue 11

When Is a Decision Reimbursable?

Many commercial carriers have providers in an uproar regarding the carrier's interpretation of the global surgical package. Here is the scenario:Patient presents to the Emergency Room for evaluation, and after evaluating the patient, the ER provider determines that the patient's condition warrants an evaluation by a surgeon. The surgeon comes to the ER, evaluates the patient, and makes a decision for surgery. The patient is immediately taken to the OR for surgical intervention.When reimbursing this service, many carriers are not allowing two (2) E&M visits on the same date of service and therefore are bundling the surgeon's...

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