ED Coding and Reimbursement Alert

Question:  I had a patient come in with a laceration that was repaired using a simple single layer technique, but two days later that same patient presents with an infection.  Am I correct, that this still falls under the global period and is not separately billable?

Georgia Subscriber

Answer:  The global period for simple laceration repair codes is zero “0” global days as of 2012.  So if you’re working with a payer who follows Medicare’s global days, any service rendered after the day of the simple repair procedure, may be separately reportable.  Modifier 24 (Unrelated evaluation and management service by the same physician or other qualified health care professional during a postoperative period) may be requested by some payers, but technically shouldn’t be required.

If the repair were intermediate or complex, the decision to report an additional visit will depend on whether the patient has Medicare, or an insurance carrier that follows Medicare’s definition of the global.  For Medicare, most complications that occur within the global period are inclusive in the payment for the procedure. 

For non-Medicare payers that don’t follow Medicare’s definition of what’s included in the global period, only treatment of typical recovery from the procedure is included in the global.  So in most of those cases, treatment of the post-procedure infection is going to be separately reportable.