# 20610 - I'm feeling quite



## Lisa Bledsoe (Jan 15, 2009)

I'm feeling quite dumb today.  Would it be appropriate to code 20610 during a global period for the same knee?  The patient is still having pain and yes, she is Medicare.  Can I code 20610-79


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## mbort (Jan 15, 2009)

ONLY because the patient is Medicare, you will be unable to capture for the injection/aspiration, this is considered part of the global surgical package for Medicare.  The only way to capture anything like that post operatively is to take the patient back to the operating room.

This is for MEDICARE patients only.  This directive is regarding the 24 modifier, but see the example that is highlighted.

Medicare B News Issue 180 Mar 2000 
Publish Date March 2000 
States Affected AK,AZ,CO,HI,IA,NV,ND,OR,SD,WA,WY 
Subject MODIFIER 24 - Appropriate Use 
"Medicare reimburses surgical procedures under a Global Fee Methodology. According to HCFA guidelines, payment is allocated on a percentage basis for preoperative, intraoperative and postoperative care. 

Based on a complex medical review of claims during October through December, 1999, this carrier has identified that some providers incorrectly use MODIFIER 24, which indicates an unrelated E/M service by the same physician during the postoperative period. 

Postoperative care includes all related E/M services rendered from the day of the surgery through the end of the indicated global period, as established in the Medicare Physician Fee Schedule. Any routine followup, consisting of an office visit, a surgical procedure performed in the office due to postoperative complications, or admission and follow up E/M in the hospital, should not be billed as a separate service. These services are considered to be included in and part of the global service period of the surgical procedure. 

Examples: 
Status post knee surgery: The patient returns with increased pain and swelling. Physician performs an ARTHROCENtesis. Both the E/M visit and procedure code 20610 are included in the postoperative fee. 

Patient is status post mastectomy: The patient returns to the office after a fall at home, with bruises on arms and legs. An E/M service with a MODIFIER 24 is justified as a separate, non-surgery-related visit."


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## Bella Cullen (Jan 15, 2009)

I thought you could bill 20610-58, for related procedure or service during the postop period. 
Daisy


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## mbort (Jan 15, 2009)

not for Medicare..other payors..yes


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## Lisa Bledsoe (Jan 15, 2009)

Thanks Mary - I was pretty sure you would come through with an answer for me!   

I don't know why I was drawing a blank today.
Thanks again!


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