# Postop Infection



## Hopp (Jul 7, 2008)

Just wondering if you can bill an E&M during a post op global.    Pt was readmitted to hosp. due to infect.  after sx.
Doc saw pt in office and performed an E&M  and put for DX code:  Post OP infection; however pt. is still in global.  Do I bill the E&M with a 24 modifier or is it post op?    Thanks


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## Treetoad (Jul 7, 2008)

Unless the patient is taken back to the OR, the E&M service would be global.


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## dmaec (Jul 7, 2008)

I know Medicare does not pay post op infections, etc unless it is a return to surgery. However, I have seen other carriers pay for care for postop infections, pain, etc... usually because it is then above and beyond the "normal" postop followup.


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## Candice_Fenildo (Jul 7, 2008)

Just because other payers "pay for it" does not mean that it is right. If it is in the Global Period then why do it.


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## dmaec (Jul 7, 2008)

and visa/versa - just because Medicare ONLY pays if it's a return to the operating room - doesn't mean it shouldn't be covered.


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## mmelcam (Jul 8, 2008)

If you look in the CPT book under surgery guidelines, it states that "typical" postoperative follow-up care is included in the surgical package. A post-op infection is not "typical" postoperative care. I would bill it with a 24 modifier and the post-op infection diagnosis. With that said, Medicare rules clearly state that any follow-up visits related to the recovery of surgery is included in the surgical package and therefor can not be billed seperately. If this is a Medicare patient I would not bill it because it is included in the surgical package per Medicare guidelines. I hope this helps.


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## dmaec (Jul 8, 2008)

I code/bill post op issues for other insurances because you can; if it's above and beyond the "norm" for post op follow up - to my knowledge, only Medicare requires it be a "return to operating room" for payment be considered for post op issures during global period"

and yes, with a modifier .24 as mmelcam states


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## mbort (Jul 8, 2008)

I agree with Donna and Melissa.  Post op infection is above and beyond the norm and the E/M should be billed with the -24 modifier with the appropriate diagnosis for the infection.


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## Treetoad (Jul 8, 2008)

Our BC/BS carrier does not pay unless it's a return trip to the OR either.


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## beck627 (Jul 9, 2008)

I agree. I have found that many insurance carriers use Medicare guidelines for their decisions on whether or not something is payable. Just my 2 cents...


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