Wiki coding I & D with foriegn body

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grosicsl

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patient had some redness in the groin area from getting hit with some thorn branches. the doctor made a small incision and some pus was eliminated and a piece of thorn was removed. this was billed with cpt 10120(removal foreign body). Patient came back in 3 days later and at that time the office note indicates that now he has a groin abscess in which the doc did an I & D. Now he billed cpt 10060. I wasn't sure if its ok to bill this way since there is a 10 day postop for minor procedures and it was done in the same place as the first time?? I work in PCP office so don't get many of these type issues.
Please advise! Thank you!!!:
 
Although it seems unfair, you cannot bill for the I&D, because it is for treatment of a complication of the original surgery and thus included in the global fee. (CMS states that procedures performed during the global period are payable only if they are "not reoperations or treatment for complications." )

Modifier 78 can only be used for "unplanned return to the operating/procedure room" and CMS defines "operating/procedure room" very narrowly as
"a place of service specifically equipped and staffed for the sole purpose of performing procedures. The term includes a cardiac catheterization suite, a laser suite, and an endoscopy suite. It does not include... a minor treatment room."

Source: http://www.cms.gov/Outreach-and-Edu...oducts/downloads/GloballSurgery-ICN907166.pdf

I have not been able to discover any commercial payer's rules on surgery for complications during the global period, and it is possible that some of them may define "operating/procedure room" more broadly. Note, however, that even the CPT book states that modifier 78 can only be used when it "requires the use of an operating/procedure room." So an I&D, which can be done right in the exam room, would definitely not qualify.
 
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