January 9, 2020
Question:
I have a question about post op visits for PE tubes (code 69436). As you know, these have a 10 day global period but my group of physicians prefer to see these patients back in 4-6 weeks. They state 10 days is not enough time to verify the tubes are working. Also they are not wanting to charge an office visit code as a post op visit is included with the fee for surgery. Please advise if we should be charging for the first post op visit for 4-6 weeks after tube placement.
Answer:
Good question and this is one of the reasons why CMS wants to eliminate the 10-day post-operative global period…because people aren’t seeing the patient within that 10-day period and then charge for when they do see the patient.
CMS values CPT 69436 for the procedure and 1 post-operative visit. CMS assumed the surgeon would see a patient within 10 days following this procedure. Therefore, the intent of that 10-day global period is that the first postoperative visit to check the status of the tubes is included in the payment for the surgeon’s fee, and payment for the procedure, and not separately reported.
If you think about it, 69436 would be a 0-day global period if no post-op visits were included. The fact that a 10-day global period is assigned means that some separate post-op care is expected.
*This response is based on the best information available as of 01/09/20.
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