ED Coding and Reimbursement Alert

Question: Our ED doctors have patients with abscess I&Ds come back multiple times during the 10 day treatment period. When asked why this was a routine process, the physician said "he wasn't sure the patient would keep it clean and it would heal, so he wanted the ED nursing staff to take care of it." He himself seldom looks at the wound, unless asked to do so by the nurse. According to CMS, this has a 10 day global period. I have not given the professional side any billing. The doctors are disagreeing with this; what would do you do?

Alaska Subscriber

Answer: For codes such as an I&D with a 10 global, dressing changes and wound checks would be included in that global period so you would not be able to bill again for the physician services. If the follow up care was atypical non-routine care, such as for curetting, changes of medications, or additional treatments, then you would consider reporting an additional service.

Typical Post-Operative Care is included in the global period. Packing removals may represent "typical care," as the packing removal is an inherent and expected component of the original Incision and Drainage.