Medical Billing Question / Continuation of Care

[sharpstick777]

I have seached the Web but could not find a good guide to what diagnosis' receive what time period for Continuation of Care.

For example, with Cataract Surgery a post-op follow up is covered for the patient under continuation of care, so in most cases an extra copay would not be charged.

If any of you medical billing guru's have a list I would most appreciative.

Sharpstick

[bwoz]

I hope I'm understanding your question right....
The global post op time frame depends on the CPT procedure done, and what the payor guidelines are for it. There's no way around that. But if you see someone during a post-op period and it's for something other than what the surgery was for, the unrelated diagnosis will show the medical neccessity. Some payors like to see the modifier too.
Hope that helps.

[sharpstick777]

I hope I'm understanding your question right....
The global post op time frame depends on the CPT procedure done, and what the payor guidelines are for it. There's no way around that. But if you see someone during a post-op period and it's for something other than what the surgery was for, the unrelated diagnosis will show the medical neccessity. Some payors like to see the modifier too.
Hope that helps.

That is along the lines Barb of what I am asking, but my question regards more than just surgery (which is usally 30 days w/o complications). If a patient has conjunctivitis and the Dr wants to see the patient again tomarrow for a f/u (same diagnosis) is that considered continuation of care? Do we charge another copay? I have had a couple of claims denied lately for continuation of care but want to know before we bill which diagnosis recieve which CC periods.

Thanks,
Sharpstick
PS Billing is my weakest area

[bwoz]

My guess without seeing the actual denial/codes etc, would be that it's a payor specific policy where they want to see specific code sets for f/u visits. For example, some payors allow comp eye codes for the initial, then they want e/m codes for any f/u. It may be some strange policy that just doesn't allow their members continuation of care for certain dx's, but I'd make sure to get that in writing from them if that's the case. I'd be pretty ticked if my Insurance didn't pay for f/u visits for a problem.
Don't worry, billing is a weak point for everyone. Just when you think you have it down, they go and change the rules ;)