Family Practice Billing Management: Receiving Payment for Surgical Procedures
October 1, 2008

In the course of business in any family practice, it is sometimes necessary to call upon the assistance of a surgeon when patients need care outside the expertise of the practice’s physicians. Family practitioners may find it easy enough to call upon a trusted surgeon for his or her patient, but knowing when it is appropriate to bill for services related to surgical procedures sometimes may be difficult to understand.

Alternately there may be occasions when a surgeon is presented with a patient that may need care outside his or her abilities and finds it necessary to send a patient to a family practice physician for a preoperative evaluation.

Although global surgical billing codes typically account for all reimbursable services provided in relation to a surgical procedure as provided by the surgeon performing the procedure, there are circumstances where it may be appropriate for a family practitioner to bill for certain elements of the surgery. It is generally acceptable for a family practitioner to bill for services provided while working with a surgeon in the following scenarios:

Prior to the Surgery

Preoperative Consultation: When a patient requires a preoperative consultation, such as when the patient has comorbid conditions (e.g. heart disease, hypertension, diabetes, etc.), a family practice physician may bill for a consultation. It is required that the physician properly documents the surgeon’s request and the procedures performed.

Office Visit: An outpatient visit code (99201-99215) is called for when a surgeon requires a history and physical for a patient but does not request any sort of advice or opinion on a medical matter.

Hospital Admissions: A family practitioner may bill for admitting a surgery patient to a hospital (99221-99223) if the operating surgeon does not have admission privileges or if the patient is otherwise admitted for a condition that later leads to required surgery.

During Surgery

Assistant Surgeon: An 80 modifier code (#####-80) may be added to a surgical procedure code in order to allocate a portion of the global surgical package fee to the family practitioner for reimbursement if he or she has been asked to assist in a surgery.

After Surgery

Postoperative Care: When problems arise that the surgeon does not feel that he or she should address, it may be necessary for a family practitioner to consult the surgeon or to altogether provide postoperative care for a patient. In these cases, it is appropriate for the family practitioner to bill for the related services. Also, in the case where a surgeon may not normally provide care in the patient’s locality, a family practitioner may be relied upon to provide postoperative care. This type of service is billed for using a 55 modifier to denote that the physician has strictly provided care for the patient post-surgery.

In all cases, it is important that the surgeon and family practitioner maintain proper documentation and communicate their understandings of what is being asked for and who will be responsible for which services. Following through with proper coding will ensure that every party receives payment when payment is due.