General Surgery Coding Alert

Question: Can you charge for admit, surgery and IV antibiotics when a patient returns to the doctors office with a groin infection? A patient was taken back into surgery for an incision and drainage (I&D) abscess of the right groin by the same physician that performed laparoscopic hernia repair previously.

Anonymous MA Coder

Answer: A physician using a hospital or ASC to perform surgery may only report the professional services provided, not supplies or incidental procedures performed by hospital nursing staff, says Rita Scichilone, MHSA, RRA, CCS, CCS-P, a manager in the coding products and services division of the American Health Information Management Association (AHIMA). This is different from a physicians in-office procedure, where supplies and nursing procedures performed represent additional overhead expense and are often separately billable to insurance plans.
Medicare has special rules that apply to complications for procedures that may not apply to other payers. Professional services are billable, as is the initial laparoscopic surgical repair (56316-56317, inguinal hernia) and the I&D of the groin abscess (10060, or 10180, complex).

However, Medicare bundles all postoperative care (i.e., office visits) into the surgical service and does not allow separate payment, unless there is a return to the OR or unless the follow-up visit is not related to the original surgery. Medicare pays only for the operative portion of the procedure, and will not allow the preoperative or postoperative allowance for the second procedure.

According to Medicare guidelines, hernia surgery has a 90-day global period where office visits may not be reported. A new postoperative period begins with the subsequent surgery, but since the I&D procedures were done in the office, there would be no charge. Other payers may use 15-, 30- or 60-day global periods.

Had the patient been brought back to the operating room for the I&D, the 10060 or 10180 was billable using modifier
-78 (return to the operating room for a related procedure during the postoperative period). However, Medicares fee schedule reduces the payment for the -78 modifier to the intraoperative percentage only.

Note: When modifier -78 is used, the clock on the original global period does not restart.