# Injections during post op period



## lewisbr (Sep 10, 2013)

Hi fellow coders, question If a patient presents back to the office during a post op period for normal follow-up care and reports pain in the knee where the surgery was performed, the physician examines the surgical site and suggest or recommends a series of injections, can this be billed? or would this be included in the global as a complication and not sent out to the insurance? This is a discussion we are having in our office. thanks for feedback.


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## OCD_coder (Sep 10, 2013)

Pain management is inclusive to the global package for Medicare/Medicaid patients and you cannot bill for these services.  

For other carriers I would check their global surgical policies to be sure that pain management was not included.  This would be considered an added course of treatment and per CPT pain management is not included in the global package.


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## sgremmels (Oct 15, 2013)

We too are having the same discussion in our office as far as injections during the global. My surgeon doesn't understand why I can't bill for an injection during global for an effusion or for arthritis after he did a meniscectomy.  He did do a chondroplasty and has a post op dx in the op note of osteo...now he wants to give synvisc injections.  I need documentation from the AAOS if anyone knows of any....any leads would be appreciated.


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## OCD_coder (Oct 15, 2013)

Synvisc is for the treatment of osteoarthritis, this is not a complication.  We do postop Synvisc injections and apply modifier 78 when performed by the same provider in the same knee joint that a surgery was performed.  Limit your Dx to follow the LCD.  

Complications and pain management is inclusive to the global package and not billable by carriers that follow MCR guidelines.


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## nyyankees (Oct 16, 2013)

OCD_coder said:


> Synvisc is for the treatment of osteoarthritis, this is not a complication.  We do postop Synvisc injections and apply modifier 78 when performed by the same provider in the same knee joint that a surgery was performed.  Limit your Dx to follow the LCD.
> 
> Complications and pain management is inclusive to the global package and not billable by carriers that follow MCR guidelines.



78 mod requires return to OR - aren't you doing injections in the office setting? I have always been told that this is tricky - that unless there is clear documentation of the OA before the surgery the carriers will give you a difficult time.


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## OCD_coder (Oct 16, 2013)

We had to learn by process of elimination a bit.  We tried modifier 79 first and sometimes it works with no denials; we ruled out 58 as the osteoarthritis was not related to the chondroplasty or meniscectomy that was performed prior.   We have had the best success with clean claims and no denials with the Modifier 78; the description includes OR or "procedure room" so we didn't get hung up on the patient not going to the OR to describe what is being performed.  We have to understand what the surgery was for prior to what the injection is for and if they are really related to two different disease processes going on.  

Based on experience and years of doing ortho coding, most providers document the first time they read x-rays all of their findings which typically include osteoarthiritis is present.  So if your providers are not reading the x-rays to their full extent, it just might be an educational moment for them.

Best practice would be to have the different treatment plans in place prior to any surgery.


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