Orthopedic Coding Alert

Question: If a patient has a postsurgical hematoma during the global period, can we bill an E/M code with modifier -24 appended, or is the visit included in the global package?

Texas Subscriber Answer: If the patient is a Medicare beneficiary, you cannot bill an E/M visit (99201-99215 for outpatients) during the global period to treat a postoperative hematoma. Medicare will only pay for a visit during the postoperative global period if the patient has a complication severe enough that the physician must return him to the operating room.
 
If you treat a privately insured patient for a postoperative hematoma, you should report the E/M service with modifier -24 (Unrelated evaluation and management service by the same physician during a postoperative period) appended, because the hematoma would not constitute "typical postoperative follow-up care."