Postoperative Period – Transfer of Care

When a surgeon performs a major surgical service and is not available to provide the postoperative care for the patient, care may be transferred to another physician. Most commonly this occurs when an itinerant surgeon performs a major surgery and a local physician agrees to provide the subsequent care for the patient.   Although the postoperative care has been transferred, the surgeon may still provide (and may be paid for) some care during the postoperative period. The physician who accepts care of the patient postoperatively will be paid for all services rendered.

Claims for postoperative care services when care is transferred from the surgeon to another physician are to be made in accordance with Rule of Application #31.

Postoperative Surgical Care:

“Postoperative Surgical Care is the responsibility of the surgeon. If a postoperative patient is transferred to the care of another physician, that physician may claim for the services rendered, and benefits paid to this physician may be deducted from payment made to the surgeon up to a maximum of 15% of the surgeon’s fee”           

Note that this rule must be read in conjunction with Rule of Application #23 which indicates that the benefits for MAJOR surgical services include three (3) weeks postoperative care.

Billing Notes:

  • Where the surgeon intends to transfer postoperative care following a major surgery, the surgical claim should be submitted at 85% of the listed fee(s) and include the remark “delegation of postoperative care.
  • When postoperative care is transferred following minor surgery, the services provided by each physician should be claimed in the usual manner in accordance with the Physician’s Manual.
  • When care is transferred, the surgeon may still claim for any postoperative care that he may provide. The surgeon’s total fee for the surgery (paid at 85%) and postoperative care, however, may not exceed 100% of surgical fee.
  • The physician who agrees to provide the postoperative care should claim for all services provided. In particular, this may include tariff 8520 Hospital Care – Per Day, which should be claimed from the day that care is transferred until the day of discharge inclusive.
  • The physician who agrees to provide postoperative care is also entitled to be paid for any surgical assist or anesthesia services, which he may have rendered during the patient’s surgery.

Questions?

Ian Foster
ifoster@docsmb.org
(204) 985-5854

 

Updated: November 2016