January 19, 2017
My group has a policy that orthopaedic surgeons deal with patient’s post-operative pain for 6 weeks and then they are referred to the physiatrists in the group to manage all on going pain. Can the physiatrist bill for these E/M visits since they are a different specialty even though the patient is in the global period?
Post-operative pain management is included in the global for 90 days. The fact that the group has made this decision would create a problem if they went ahead and billed for this service. The fact that the group mandates that ALL PATIENTS MUST SEE PM&R after 6 weeks is not medically necessary. Whatever PM&R does during the 90 days is free…. UNLESS it is pain way outside the box, documented, uncontrollable by normal standards. Uncommon treatment is totally differently than the standard. This would be a rare occurrence.
Post-operative pain is not unrelated so use of modifier -24 is inappropriate for routine care. If there were the rare occurrence mentioned above then it would be appropriate to use modifier -24 with a diagnosis to support the condition (An ICD-10 in the G89 or F45 series depending on the circumstances but doing this routinely would raise a red flag.)
*This response is based on the best information available as of 01/19/17.