ED Coding & Reimbursement Alert - 2014 Issue 8
Modifiers: Read This if Your Surgeons Ever Divvy Up Care
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Article Overview
This article covers how shared surgical care is handled during the global period when more than one physician is involved in a patient’s preoperative, operative, or postoperative management. It focuses on the billing and documentation coordination needed to support claims, including payer communication, transfer-of-care documentation, and how different contractors or insurers may process the services. The piece is aimed at coders, billers, compliance staff, and physician practices that need to understand shared-care workflows for surgical claims.
Why This Topic Matters
Shared-care situations can affect claim payment, claim approval, and documentation requirements. Understanding the billing structure helps practices coordinate with other offices and reduce denials when surgical care is divided among providers.
Article Sections
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Transfer the Care
Introduces a shared-care scenario involving surgical care followed by another physician during the global period. It discusses the need for documentation of care transfer and the general circumstances that may lead to split management.
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Append a Modifier to the Surgical Code
Explains that the payer must be informed when different physicians handle portions of the surgical package. It addresses general modifier use in shared-care billing and notes payer recognition differences.
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Check the Payment Impact
Describes the broader reimbursement effect of multiple physicians furnishing services within one global surgical package. It notes the general payment relationship between combined services and a single-physician service.
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Coordinate Billing
Focuses on communication between practices when more than one office participates in care. It also discusses claim submission coordination, contractor jurisdiction, and the need to align billing across the involved providers.
What You Will Learn
- How shared surgical care is structured during the global period
- Why documentation of care transfer matters for split billing
- How payer communication affects billing for portions of surgical care
- Why coordination between offices is important in postoperative management
- How contractor jurisdiction can affect claim submission workflow
Who Should Read This
- Medical coders
- Medical billers
- Physician office staff
- Compliance professionals
- Surgical practice administrators
Codes Discussed
Modifiers Discussed
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