Wiki capture charges for complex debridement within global period ?

[Lubovic]

Hello,
My doctors asked if there is a way to capture charges for 97597-8 Debridement (eg, high pressure waterjet with/without suction, sharp selective debridement with scissors, scalpel and forceps), open wound, (eg, fibrin, devitalized epidermis and/or dermis, exudate, debris, biofilm), including topical application(s), wound assessment, use of a whirlpool, when performed and instruction(s) for ongoing care, per session, total wound(s) surface area; first 20 sq cm or less.
This occurs post surgery within the global period.

Some of these wound dressing changes are complex and require almost an hour to complete because it's not just dressing change, it also entails debridement as the wounds heal. The code 97597 perfectly describes the procedure and time involved, and is usually performed by an NP/APP or sometime two of them due to the complexity. (My NPs/APPs are billable under their own NPI).

So I am wondering if the doctor notates something like " complex wound that staged complex dressing changes will be medically necessary" can we use Mod-58 to indicate it's a staged procedure?
Or if anyone knows any other way to bypass global because these specific wound dressing changes are not standard, require debridement, more time, and assessment?
I appreciate your input.

 

[Deborah Marsh]

Hi - I found this in another thread - https://www.aapc.com/discuss/threads/97597-allowed-in-a-global.180174/. Maybe the forum for the specialty involved would have a more on-point answer. Best of luck!

 

[thomas7331]

Hello,
My doctors asked if there is a way to capture charges for 97597-8 Debridement (eg, high pressure waterjet with/without suction, sharp selective debridement with scissors, scalpel and forceps), open wound, (eg, fibrin, devitalized epidermis and/or dermis, exudate, debris, biofilm), including topical application(s), wound assessment, use of a whirlpool, when performed and instruction(s) for ongoing care, per session, total wound(s) surface area; first 20 sq cm or less.
This occurs post surgery within the global period.

Some of these wound dressing changes are complex and require almost an hour to complete because it's not just dressing change, it also entails debridement as the wounds heal. The code 97597 perfectly describes the procedure and time involved, and is usually performed by an NP/APP or sometime two of them due to the complexity. (My NPs/APPs are billable under their own NPI).

So I am wondering if the doctor notates something like " complex wound that staged complex dressing changes will be medically necessary" can we use Mod-58 to indicate it's a staged procedure?
Or if anyone knows any other way to bypass global because these specific wound dressing changes are not standard, require debridement, more time, and assessment?
I appreciate your input.

I don't think that the modifier 58 is going to be supported here as this doesn't really meet the definitions of a staged procedure, which is generally one that is planned in advance of, or is more extensive than the original procedure. Also, if audited, I don't think that a payer is going to buy the argument that this should be paid in addition to the global surgery fee simply because it is complex and time-consuming to the providers. The global fee is intended to cover all recovery costs, even if some patients require more care than others.

This is kind of a tough situation getting into a grey area. My suggestion is that you read through CMS's publication, linked here: Global Surgery Booklet. Look at the list of items included and excluded on pages 5 and 6. You'll see that the global period includes "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", so if these treatments are clearly for a complication such as a non-healing surgical wound, then they are considered included and shouldn't be billed with a modifier. But you can also see that "Treatment for the underlying condition or an added course of treatment which is not part of normal recovery from surgery" is not considered included, so depending on the specifics of your patient's case, and how it is documented, there may be some room to make an argument that this wound care is not related to the surgery itself but could be due to a disease process unrelated to the procedure, in which case a modifier 79 might be appropriate. I'd just recommend that if you decide to bill it, make sure that your documentation and coding clearly follow these guidelines and that you are prepared to make a case to defend it in the event you are audited.

Hope this may help some!

 

[Lubovic]

I don't think that the modifier 58 is going to be supported here as this doesn't really meet the definitions of a staged procedure, which is generally one that is planned in advance of, or is more extensive than the original procedure. Also, if audited, I don't think that a payer is going to buy the argument that this should be paid in addition to the global surgery fee simply because it is complex and time-consuming to the providers. The global fee is intended to cover all recovery costs, even if some patients require more care than others.

This is kind of a tough situation getting into a grey area. My suggestion is that you read through CMS's publication, linked here: Global Surgery Booklet. Look at the list of items included and excluded on pages 5 and 6. You'll see that the global period includes "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", so if these treatments are clearly for a complication such as a non-healing surgical wound, then they are considered included and shouldn't be billed with a modifier. But you can also see that "Treatment for the underlying condition or an added course of treatment which is not part of normal recovery from surgery" is not considered included, so depending on the specifics of your patient's case, and how it is documented, there may be some room to make an argument that this wound care is not related to the surgery itself but could be due to a disease process unrelated to the procedure, in which case a modifier 79 might be appropriate. I'd just recommend that if you decide to bill it, make sure that your documentation and coding clearly follow these guidelines and that you are prepared to make a case to defend it in the event you are audited.

Hope this may help some!

Thank you, yes, that makes sense. That's why I asked because we do have this gray area. However I also appreciate that the doctors an non physician providers were spending great amount of additional time on these debridements that are "not part of the standard recovery". I will have the doctors include verbiage about the "disease process", they already do, but maybe they can add more; and see if we can use mod 79. My coder did bill out mod-58, I'll post an update regarding payment either way.

Hi - I found this in another thread - https://www.aapc.com/discuss/threads/97597-allowed-in-a-global.180174/. Maybe the forum for the specialty involved would have a more on-point answer. Best of luck!

thank you for your reply. this did help too.