General Surgery Coding Alert

Question:

Tennessee Subscriber

Although this certainly falls within 10060's (Incision and drainage of abscess ...) (I&D) 10-day global period for surgical packages, you must consider whether the post-op infection is directly related to the surgery. The answer will impact whether you can bill a separate encounter or include it in the global package.

Post-op infections do not necessarily stem directly from the surgery. Factors such as age, hygiene, presence of concomitant illnesses, poor wound healing, compliance with antibiotic medications, post-op care, and environment all contribute to the development of post-op infections. These factors are not related directly to the surgery.

Considering the above factors, it would be reasonable to code a separate E/M service (99212-99215, Office or other outpatient visit for the evaluation and management of an established patient ...) for this post op visit and use modifier 24 (Unrelated evaluation and management service by the same physician during a postoperative period).

CPT guidance supports this approach with the note, "Follow-up care for therapeutic surgical procedures includes only that care which is usually a part of the surgical service. Complications, exacerbations, recurrence, or the presence of other diseases or injuries requiring additional services should be separately reported."

Medicare is different: Medicare considers many developments within the global period part of the surgical package unless it involves a return to surgery. There are exceptions, such as pre-existing conditions, unrelated conditions that are new during the global period, and treatment of the underlying disease process that the surgery didn't cure. In your example, if the I&D was part of treatment for a systemic infection, you may be able to separately bill Medicare for the separate E/M during the global period. But Medicare is unlikely to pay separately for an E/M to treat an infection at the operative site.