Wiki Billing complications in global period

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vkratzer

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The Administrator in our office is telling me that we can bill an abscess of a surgical wound in the post op period because CMS guidelines state "treatment for the underlying condition or an added course of treatment which is not part of normal recovery from surgery" is not included in the global surgical package. I interpret this as treating an underlying condition which may be contributing to the cause of the abscess (we could bill) but if we are only treating the abscess and not managing the underlying condition, her interpretation is incorrect. I would consider this a complication which is not billable. Her interpretation of this is that an abscess is not part of normal recovery from surgery. She also tells me we can bill for I&D, debridement, etc done in the office in the global period for the same reason. I also disagree. It is my understanding that we can only bill for procedure if patient returns to the OR. Please help me. I do not feel comfortable attaching a 24 modifier to the treatment of an abscess of surgical wound. Am I wrong. I feel that she is pulling this out of context. Appreciate any advice.

VKratzer
 
I am not in your field but..... mod 24 is attached to visit codes, not surgical codes. Also, I agree with you. You need to be going back to the OR to bill for a "complication" separately. Can't do in the office POS. It is all part of the main surgical package.
 
I agree with you. I only bill for a return trip to OR for a "related condition". If I bill for an office visit in the post op period it has to clearly be unrelated.
The abscess is a complication not an underlying condtion or an added course of treatment. It is confusing though as to when something is considerd related or an added course of treatment. My office feels that an abscess is a typical complication from surgery. Hope this helps.
 
I know this post is a few weeks old but I wanted to add that I don't think your administrator is completely wrong. Whether you can bill for the abscess depends on the payer.

CMS has stated that complications in the post-op period are included in the global period but CPT's definition is different. Per CPT, complications can be billed with a -24 modifier (and I would say that the I&D could be billed with a -78). If the patient is not a Medicare patient, you may want to check with the payer before assuming this is included in global period.

The May 2010 Coding Edge had an article on this subject. Pages 26-29.

Lisi, CPC
eharkler@nmh.org
 
Me again. I just realized you posted this question in the "Medicare Regulations" forum so I guess you were inquiring about the CMS global period. LOL!

What you said was correct, complications are included in the global period.

glad I could help - ha ha.

Lisi, CPC
 
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