# Difficult Extubation During Global



## adri3421 (Aug 15, 2012)

If a patient with multiple comorbidities (CHF, CAD, Afib) or multiple trauma injuries has surgery and is left on the ventilator longer than normal in respiratory failure before extubation can the surgeon bill a subsequent hospital visit with a -24 modifier when he/she extubates the patient? The visit does not meet critical care guidelines due to less than 30 min spent.

Would this be considered a complication and included in the global? (Thats what Im thinking......)

Is there ever a time that a surgeon can bill for a difficult extubation (when time is not met for critical care codes) or would it always be part of the global package if they performed the extubation themselves?


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## FTessaBartels (Aug 21, 2012)

*Global*

I do not believe you can code for this separately.  Extubation is included in the E/M service, and I belive this would be considered global to the surgery.

Hope that helps.

F Tessa Bartels, CPC, CEMC


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