Pediatric Coding Alert

Question: How can I find out how many postoperative days a surgery, such as CPT 51701 (Insertion of non-indwelling bladder catheter), includes? Must I change my coding for subsequent unrelated office visits that fall within the procedure's global period?

Georgia Subscriber

Answer: Many private payers follow Medicare's postoperative surgical schedule. You can download Medicare's 2004 National Physician Fee Schedule Relative Value File from www.cms.hhs.gov/providers/pufdownload/default.asp#pfsrelative. When you open file PPRRVU04.xls, you can enter a CPT code in the finder window and scroll across to the global days field. The number in this column is how many postoperative days Medicare includes in the procedure's global surgical period. For instance, 51701 contains "000" or zero global days.

You will have to contact individual payers for their Fee Schedule . Although many adopt Medicare's guidelines, some insurers' postoperative periods for specific procedures differ from CMS'.

If you treat a patient for an unrelated service while a procedure's global period is in effect, you should append modifier -24 (Unrelated evaluation and management service by the same physician during a postoperative period) to the appropriate E/M code, such as 99212-99215 (Office or other outpatient visit for the evaluation and management of an established patient ...).

Suppose you reduce a child's radial head and bill the global fracture care code 24640 (Closed treatment of radial head subluxation in child, nursemaid elbow, without manipulation). During the procedure's 10-day Medicare global period, you also treat the child for an upper respiratory infection, URI (465.9, Acute upper respiratory infections of multiple or unspecified sites; unspecified site). In this case, the office visit is for a different problem than the nursemaid elbow. So, you should append modifier -24 to 99212-99215 to indicate that the E/M service is unrelated to the postoperative period. Link 465.9 to 9921x-25.

 - Answers to You Be the Coder and Reader Questions provided by Barbara J. Cobuzzi, CPC, CPC-H, CHBME, president of Cash Flow Solutions Inc., a premier medical billing company in Lakewood, N.J.; Kheva King, coder for Dr. Esther Akogyeram in Las Vegas; Imelda Y. Lee, RHIA, CTR, pediatric coding specialist in the department of pediatrics at the University of Texas Health Science Center in San Antonio; Charles A. Scott, MD, FAAP, a pediatrician at Medford Pediatric & Adolescent Medicine PA in Medford, N.J.; and Heather Zambrana, billing and collection manager at Farrell and South Riding Pediatrics in South Riding, Va.