Managing Post-ops

April 1, 2004

Our surgeons would like to hire an internist to follow hospitalized patients. Can an internist or medical subspecialist be reimbursed for such services if medical necessity rules are met and we code it as a consultation? If the patient needs post-op follow-up in the hospital by the internist as well as by the surgeon, how does the internist code for his services — and can we expect to be paid?

Question: Our surgeons would like to hire an internist to follow hospitalized patients. Can an internist or medical subspecialist be reimbursed for such services if medical necessity rules are met and we code it as a consultation? If the patient needs post-op follow-up in the hospital by the internist as well as by the surgeon, how does the internist code for his services - and can we expect to be paid?

Answer: The situation you're describing does happen all the time in tertiary care centers. Institutions like Mayo Clinic routinely get patients for surgery but send the patient back to their regular physician for the post-operative care.

Code the visits with these modifiers, as appropriate:

  • -56 Preoperative management only
  • -54 Surgical care only
  • -55 Postoperative management only

The carriers price the services so that they add up to the global payment. Of course, that's in a perfect world, so you'd need to watch for denials and underpayments very closely if you go down this path.

You'll also want to consider the malpractice issues. The vast majority of tertiary care institutions are sending patients back to a physician of the same specialty (i.e., a cardiovascular surgeon back to a cardiovascular surgeon, not to the family practitioner). If there is an adverse outcome, and the internist is managing the postoperative care for your surgeons, and billing for it, this might open your group to exposure if the standard of care is for the surgeon (or a surgeon) to manage the patient postoperatively. This would be a critical discussion to have with your malpractice carrier before you went down this route.

Most surgical groups in the situation you're describing look for a physician assistant or a nurse practitioner to work as a partner in the surgical care team to avoid the concerns that I described above.