# post op hematoma



## codegirl0422 (Apr 25, 2008)

Help with post op situation:
is within a post operative period (10 or 90), the doctor performs incision and drainage of hematoma 10140 or performs incision and drainage of abscess 10060 -- is this part of the surgical package? The way I read Medicare's guidelines it is. I have one doctor saying yes and another saying no. The one saying no, is saying it is above and beyond the normal post op care. But since he is doing these in the office, I am unclear on the appropriate modifier, if it can be billed.  I thought I had it straight till my meetings with the doctors and my office manager. 

Any guidance would be greatly appreciated. Thanks in advance


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## codegirl0422 (Apr 29, 2008)

bringing post back to the top of list.  Does anyone have any opinions on this? Thanks for any help.


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## Erica1217 (Apr 29, 2008)

It's included per CMS's guidelines... but not included per CPT guidelines... so both your docs are right in a way... it depends on what kind of insurance the patient has.  

For Medicare and any payor who follows CMS guidelines, treatment of post-op complications are included unless the patient is returned to the operating room.  

It's a good idea to have the Guidelines handy so you can defend yourself.. you know what you are talking about!  

Also, it's a good idea to check all of your payors' surgical package guidelines.  Most of them are published on their website....  and most ARE following CMS guidelines.  

 Erica


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## mmelcam (Apr 30, 2008)

I agree with Erica.


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## codegirl0422 (Apr 30, 2008)

I showed them this part of the CMS article, and tried explaining it is global, but the doctor still disagreed. The doctor performs office procedures in the office, removal of lesions etc that do not warrant the hospital OR, so he is telling me it is ok, he is doing it in an operating room, to use modifier 78. (The changes in the wording of modifier 78 this year, leans the doctor to this modifier.

_A. Components of a Global Surgical Package
"Complications Following Surgery - All additional medical or surgical services
required of the surgeon during the postoperative period of the surgery because of complications which do not require additional trips to the operating room;"_

But then there is this following statement, in the manual, and according to the doctor and his wife, the hematoma is not part of normal recovery from surgery. I somewhat agree, but to me when there are abdominplasty, or surgeries of that extent etc done, a hematoma (maybe not part of normal recovery) could be expected to happen, and I do not see the medical necessity in billing for it. Plus, then I would have to use modifier ?, modifier 79would not be correct, it is not unrelated (without the procedure being done the patient would not have had the hematoma); could you use modifier 58, I know it is not stage, but in the reading of the description it states "or related procedure"

_B. Services Not Included in the Global Surgical Package
"Treatment for the underlying condition or an added course of treatment which is not part of normal recovery from surgery;"_

the quotes are from Chapter 12 of CMS Medicare claims processing Manual.

confused, I had this straight, but know with the doctors view, I am needing other coders opinions. and opinions how to address this to the doctor and his wife. The insurance person before me was adding modifier 24 to the px   The doctors wife's opinion is if we have to go back to the hospital OR we will. again I am scared the doctor would be faced with medical necessity.

Sorry for such a long reply, I think I may be putting too much into this.

codegirl0422, CPC, CBCS







Erica1217 said:


> It's included per CMS's guidelines... but not included per CPT guidelines... so both your docs are right in a way... it depends on what kind of insurance the patient has.
> 
> For Medicare and any payor who follows CMS guidelines, treatment of post-op complications are included unless the patient is returned to the operating room.
> 
> ...


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## Erica1217 (May 5, 2008)

No YOU are not, your doc and his wife are.  She actually is going to convince her husband to bring patient's back to the OR just get additional reimbursement they do not deserve?  That is ridiculous and abusive behavior.  I feel for you.  

If they are doing it in the office and it does not *require* a return trip to the OR, then it's part of CMS's global surgical package.  

Modfier -79 and -58 are not correct.  See these links -
http://www.medicarenhic.com/providers/articles/surgerymod_1207.pdf

http://www.medicarenhic.com/providers/pubs/surgeryguide.pdf


"Treatment for the underlying condition or an added course of treatment which is not part of normal recovery from surgery;" does NOT include minor complications of surgery.. those are clearly included per CMS guidelines.  


If they insist on adding modifier -24 for E&Ms or -79 for procedures, they are putting themselves at risk.  This is fraud.  Both modifiers would be telling Medicare that the services are unrelated to the surgery and that is ..well.. it's a big fat lie.  

Good luck!!!!
 Erica


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## codegirl0422 (May 5, 2008)

Thanks Erica, that is the way I feel but I can't convience them differently. I sorta understand where they are coming from but it doesn't work that way. I appreciate you taking the time to respond again. I know I knew it the right way but then after a meeting or two with them, I started to doubt myself.


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