EM Coding Alert

Question: One of the surgeons in my practice had a patient make an appointment to come in because he developed an abscess in his stitch from his minor operation several days prior. The patient is still within the 10-day global period of the surgery. The abscess was draining at the site of the incision. How would I code to separate the E/M service from the surgical global period?

Nevada Subscriber

Answer:  You would report the appropriate established patient code from the 99211-99215 (Office or other outpatient visit for the evaluation and management of an established patient …) range, based on the documented level of service for the E/M encounter. Append modifier 24 (Unrelated evaluation and management service by the same physician or other qualified health care professional during a postoperative period) to indicate that the E/M service is separate from the surgical global period. 

The diagnosis of an abscess in his stitch is the reason for the E/M service. Without the modifier, your payer will deny the claim because the office visit is within the global period.

Exception: Medicare considers complications during the global period part of the surgical package. If the patient is covered by Medicare, the complication would have to be substantial enough to put the patient back in the operating room before you could report a separate encounter during the global period. For a complication treatment in the office, you won’t be able to bill the service.