Practice Management Alert

CMS and private payer rules and reimbursement may differ drastically. Do you automatically skip billing for post-surgical infection care during the primary procedure’s global period? If so, you should stop. You could be missing out on legitimate revenue. To determine whether you should be billing for post-op care your physicians provide, follow these two tips. Tip 1: Distinguish Between Medicare and Non-Medicare Patients Medicare treats postoperative complications, including infections, differently than insurers who follow CPT® guidelines. Although both CMS (Medicare) and CPT® guidelines indicate that the global surgical package includes "typical" postsurgical care, the two sources differ regarding what qualifies as typical -- which means you must differentiate your claims depending on which payer you are coding for. Medicare requires that a complication be significant enough to warrant a return to the operating room before you may report a separate procedure in the global period. In fact, CMS "Correct Coding" guidelines [...]