Our physician performed a total disc replacement. Approximately a week later the patient went to the ER because she was experiencing a lot of pain due to the original surgery. The patient was seen in the ER by a partner in the practice. A few days later, the original surgeon took the patient back to surgery and performed a fusion. My question is can we bill for the ER evaluation or does this fall under the global surgical package of the original surgery. This is not a Medicare patient.

While the CPT rules and Medicare rules differ in what services are included in the global surgical package, a visit where the chief complaint is pain at the surgical site would be considered “typical post operative care” by both the AMA and Medicare. There is not enough detail in terms of the findings of the visit in the ER, so based on the above description, the visit to the ER would be bundled in the surgical package and not separately reportable by Dr.Partner.The original surgeon reports his/her services with the appropriate CPT codes and modifiers (most likely, modifier -78 based on the limited information provided).

Mary LeGrand, RN, MA, CCS-P, CPC
KarenZupko & Associates, Inc.