General Surgery Coding Alert

Question: Following surgery, we had to readmit a Medicare patient for a wound abscess. Can we charge for the readmission and daily care?


Texas Subscriber

Answer: If the surgeon readmits the patient during the global period of the original surgery for the same problem that prompted the original surgery, you cannot charge for the readmission or hospital visits.

These rules apply specifically to Medicare. Medicare treats postoperative complications, including infections, differently than insurers that follow CPT guidelines. For payers other than Medicare, inquire about the insurer's guidelines regarding post-op complications.

If, on the other hand, the patient's condition and the abscess' treatment require a trip to the operating room, you may report the procedure performed and append modifier -78 (Return to the operating room for a related procedure during the postoperative period), regardless of the payer.

Finally, if the surgeon readmits the patient after the global period of the original surgery, you may report the appropriate service level for the hospital admission and subsequent care (again, regardless of payer).