decisionhealth Newsletters, Coder Pink Sheets - 2005 Issue 7 (July)
Be wary of scheduling pre-op clearance outside global period
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Article Overview
This article examines Medicare global surgery package rules as they relate to pre-operative clearance visits that are scheduled before surgery. It explains why timing alone may not justify separate billing, highlights concerns about unbundling and potential fraud, and summarizes perspectives from CMS and orthopedic coding professionals. The piece is relevant to physicians, coders, billing staff, and compliance personnel who handle surgical E/M services and global period reporting.
Why This Topic Matters
Understanding how pre-operative visits fit within the global surgical package helps avoid billing errors, compliance risk, and potential enforcement exposure. The article is useful for organizations that schedule surgical patients and submit E/M claims tied to upcoming procedures.
What You Will Learn
- How Medicare describes preoperative visits within the global surgical package
- Why the timing of a pre-op visit can raise billing compliance concerns
- How professional organizations and CMS viewpoints differ on separate billing for these visits
- What kinds of compliance risks may arise from perceived unbundling
Who Should Read This
- Physicians
- Medical coders
- Billing staff
- Compliance officers
- Practice administrators
- Orthopedic practices
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