General Surgery Coding Alert

Question: How should I bill for a wound culture? My physician may be seeing a patient postoperatively and decide to take a wound culture in the office. Is this considered post-op care and not billable?

Specifically, how should I bill for a culture done in the office if a patient comes in for nipple discharge? My physician will extract a sample of the discharge and send it to pathology. Should I just bill the E/M code, or can I bill the culture as well?

Arizona Subscriber

Answer: To provide a certain answer, you-d have to provide more information about the exact nature of the service the surgeon is providing.

Most often, the surgeon would collect a specimen and send it out to a pathologist. In such a case, the surgeon would bill only for gathering the specimen.

So, for instance, if the surgeon performed an incision and drainage (I&D) of a complex postoperative wound, she would report 10180 (Incision and drainage, complex, postoperative wound infection). If, instead, she drained a postoperative seroma or hematoma, you would report 10140 (Incision and drainage of hematoma, seroma or fluid collection), while you would report 10160 (Puncture aspiration of abscess, hematoma, bulla or cyst) for an abscess or cyst. For a more extensive debridement, 11000 (Debridement of extensive eczematous or infected skin; up to 10% of body surface) would be appropriate. In the case of obtaining a breast sample, a fine needle aspiration (FNA, 10021, Fine needle aspiration; without imaging guidance) may also be a possibility.

But if the physician simply swabs the wound or expresses material from the nipple, you wouldn't report a separate procedure code, and would instead claim only an appropriate-level E/M services (such as 99213). The physician could also possibly report 99000 (Handling and/or conveyance of specimen for transfer from the physician's office to a laboratory) for handling and shipping or transporting the specimen, although many insurers will not pay for that service.

If any of these procedures or services occurs during the initial procedure's global period, you-d have to append the appropriate modifier. For a procedure, you-d append modifier 79 (Unrelated procedure or service by the same physician during the postoperative period), whereas for an E/M service you-d have to append modifier 24 (Unrelated evaluation and management service by the same physician during a postoperative period).

As a final point, you must remember that Medicare and payers following Medicare guidelines will not pay for any treatment of postoperative complications that do not require a return to the operating room. So, if this is a Medicare patient, you would bill nothing for obtaining or handling the specimen.

-- Technical and coding advice for You Be the Coder and Reader Questions provided by Marcella Bucknam, CPC, CCS, CPC-H, CCS-P, manager of compliance education at the University of Washington Physicians.