When it comes to global surgery — all necessary services a surgeon normally furnishes before, during and after a procedure are included in the payment for the surgery — every payer has its own policies about coding and billing. Some commercial payers follow Medicare’s policies to one degree or another.
Where to find all the applicable rules? Here is a quick rundown with some high points.
- Medicare rules are in the Medicare Claims Processing Manual (PDF) in Chapter 12, Sections 40 and 40.1 — Physicians/Nonphysician Practitioners.
- The Centers for Medicare & Medicaid Services also has published a Global Surgery Fact Sheet (PDF). This 10-page book explains how to apply the Medicare policies in various situations, and provides FAQs and a list of other resources.
- Aetna — Log in to Aetna’s secure provider portal, NaviNet. Go to Claims Payment and Coding Policies. See these policies: Evaluation and Management (E&M) Services During the Global Surgery Period, and Post-Operative Days.
- Blue Cross and Blue Shield of Texas (BCBSTX) — No login required: Go to Claims and Eligibility; Claims Filing Tips. See Surgical Procedures Performed in the Physician’s and Other Professional Provider’s Office. Also: Log in to the provider section of the BCBSTX site, and see Code Editing Summary, Evaluation and Management Services.
- Cigna —Log in to CIGNA’s secure portal, Cigna for Health Care Professionals. See Code Edit Policy.
- Humana — No log-in required. See the Provider Manual Physicians, Hospitals, and Healthcare Providers — Texas, May 1, 2010. See Surgical Payments.
- UnitedHealthcare (UHC) — No log-in required. On the UHC website, Go to Tools & Resources; Policies, Protocols and Guide; Reimbursement Policies. See Global Days Policy .
Need help with coding and billing in your practice? TMA Practice Consulting offers on-site training, reviews, and check-ups. Or, ask your county medical society to schedule a TMA 30-Minute Billing Cure session in your city.
Published Aug. 14, 2012
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Last Updated On
June 01, 2016