ED Coding and Reimbursement Alert

Question: The ED physician performed an incision and drainage procedure on a patient two days ago. Today the patient returned for a packing removal, and due to some concerning redness around the wound, the physician ordered an intramuscular antibiotic injection. Should we charge for a follow-up visit?

Washington, D.C., Subscriber

Answer: The correct answer to your question depends on whether the patient's insurer is Medicare or is following Medicare's payment guidelines.

Medicare instructs that "postoperative complications" treated within the global period are only payable if a return to the operating room is required -- so for a Medicare patient, you couldn't report this service separately on the professional side.

However, CPT guidelines state that "typical postoperative follow-up care" is included in payment for the service. So for non-Medicare carriers, you can probably report the service. In your situation, this is probably not "typical postoperative care." Check with your physician, but it is uncommon in most emergency departments to administer intramuscular antibiotics on a patient's return visit unless there is a problem.

The bottom line: For Medicare patients or those patients whose payers require you to bill according to Medicare guidelines, you don't have a billable service. For all other carriers, you probably do.