Practice Management Alert

Question: A patient who is in the 90-day global period of a surgical procedure has complications related to the surgery. Can we bill for the services related to the complications? Pennsylvania Subscriber Answer: The answer depends on the payer. Medicare treats payment for post-op complications, such as infections, differently than insurers that follow CPT guidelines. The difference: Although both CMS (Medicare) and CPT guidelines indicate that the global surgical package includes "typical" postsurgical care, the two disagree on what qualifies as typical --which means you must differentiate your claims depending on the payer you are billing. Medicare rules: To report a separate code for patients with Part B Medicare for dealing with a complication within a procedure's global period, the circumstances must meet two conditions: 1. Your physician must have treated the patient's complication during a different session from the original procedure. 2. Your physician must have returned the patient [...]