Wiki 17250 in Global Period

[Ruddan]

I keep going back and forth on this. I have a patient who is status post mastectomy, and has been coming in weekly for post-operative visits. During these visits, the provider has been applying silver nitrate to the scar, but documentation states that the scar is healing normally. I'm of the opinion that we cannot bill 17250 as this would be considered normal wound care in the global (akin to a dressing change or incision care). A fellow coder suggested billing these with a 78 modifier. Can anyone weigh in?

 

[csperoni]

-78 is clearly not appropriate for services being provided in your office. -78 is "Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period."
The Medicare Global Surgery booklet is currently down for revision. However, here is an excerpt from what was last available:
What services are included in the global surgery payment?
Medicare includes the following services in the global surgery payment when provided in addition to the surgery:
• Pre-operative visits after the decision is made to operate. For major procedures, this includes preoperative visits the day before the day of surgery. For minor procedures, this includes pre-operative
visits the day of surgery.
• Intra-operative services that are normally a usual and necessary part of a surgical procedure
• All additional medical or surgical services required of the surgeon during the post-operative period of
the surgery because of complications, which do not require additional trips to the operating room
• Follow-up visits during the post-operative period of the surgery that are related to recovery from
the surgery
• Post-surgical pain management by the surgeon
• Supplies, except for those identified as exclusions
• Miscellaneous services, such as dressing changes, local incision care, removal of operative pack,
removal of cutaneous sutures and staples, lines, wires, tubes, drains, casts, and splints; insertion,
irrigation, and removal of urinary catheters, routine peripheral intravenous lines, nasogastric and rectal
tubes; and changes and removal of tracheostomy tubes

The work you are describing is part of the global surgical package.

 

[PennyR]

I keep going back and forth on this. I have a patient who is status post mastectomy, and has been coming in weekly for post-operative visits. During these visits, the provider has been applying silver nitrate to the scar, but documentation states that the scar is healing normally. I'm of the opinion that we cannot bill 17250 as this would be considered normal wound care in the global (akin to a dressing change or incision care). A fellow coder suggested billing these with a 78 modifier. Can anyone weigh in?

You would want to use modifier 58 on this. I deal with this all the time with debridements and such after podiatry procedures in the wound clinic.