Ophthalmic Coding Specialist Practice Test

Which types of adjustments must be made before billing an unrelated exam during the global period?

1. A new diagnosis must be established

2. Additional tests must be performed

3. A different physician must verify the complaint

4. The reason must relate to previous treatment

The correct answer is: The reason must relate to previous treatment

Billing for an unrelated exam during the global period involves specific criteria to ensure compliance with coding rules. The correct choice notes that the reason for the visit must relate to the previous treatment. This is essential because the global period is meant to cover all follow-up care related to a surgery or procedure. If an unrelated exam is conducted—in other words, if the complaint or reason for the visit does not relate to the prior procedure—the physician must demonstrate that this visit is necessary and distinctly separate from ongoing post-operative care covered by the global period. In practice, this means that if a patient presents with a new or unrelated issue during the global period, adequate medical documentation would be required to support the claim that this visit is necessary and distinct from the treatment or evaluation tied to the earlier procedure. This focuses on ensuring that the billing accurately reflects care provided outside of the typical follow-up associated with surgery or treatment. On the other hand, establishing a new diagnosis, performing additional tests, or requiring verification from a different physician are not foundational requirements for billing unrelated complaints during the global period. While these actions can add to the medical necessity of the visit, they are not prerequisites to justify the independent nature of the exam in question. The primary factor is that the reason for the visit