Wiki Billing for post procedural care with complication

[cwestman]

This is the first time I've seen a post procedural complication unfortunately (or perhaps fortunately) Pt 3 days post simple skin abscess 10060 following up with a different provider noted allergic reaction to Bactrium ,antibiotic was changed and treatment for allergic reaction was provided as well as increased inflammation surrounding tissue requiring further evacuation of cyst culture was obtained ,provider documented 40 minute appt with greater than 50% spent face to face counseling pt and husband on wound care,and avoidance of sulfa based drugs such as neosporin etc all questions were answered with understanding I believe this is billable (not using CPT 99024),hoping I'm right. Also since this visit was within the 10 day global is there a modifier that I should use .Honestly I've gone through every single one to no avail The second Provider did not do any more of an incision ,simple evacuation and culture Obviously this visit is related to the original procedure Different Provider I'm at a loss Hoping for a life line ,please and thank you in advance Cheri

 

[katemae84]

Are these two providers practicing in the same group practice and the same specialty? If so, then neither the E/M nor the 10060 would be billable.
Most payers follow CMS rules on Global Surgery packages, which can be found here:
CMS Global Surgery Booklet
Generally speaking, treatment of complications (whether an office visit or in-office procedure) are not separately billable when done by the same provider, or another provider in the same group practice. The exception to this rule would be for treatment of complications that require a trip to an OR.
If these providers aren't in the same practice, then yes, it's billable, but be aware that for time-based visits that also involve time spent on a procedure, the provider should be documenting his/her time spent counseling as being exclusive of time spent on the procedure. For instance, you say it was a 40 minute appt, but how much of that time was on the procedure? Time spent performing the procedure can't be counted towards the E/M level. For example, say they spent 10 minutes on the I&D procedure. That would leave 30 minutes for the E/M portion of the visit which would change the level of service for an established patient visit from a 99215 to a 99214.