Wiki debridements in post op period

[vkratzer]

Are debridements considered normal part of post operative care following amputation if performed in a Wound clinic performed by the same surgeon who performed the surgery? If so, can we bill with 58 modifier if the physician anticipates that patient will require debridements in the post operative period in the Clinic setting. MC guidelines state no complications are billable in the post operative period unless pt returns to the OR. However, guidelines also state that treatment for underlying condition "or an added course of treatment which is not part of normal recovery from surgery" is billable. I am aware that some carriers do allow billing complications in the post operative period. My question is specific to Medicare. It is my understanding that debridements would not be billable in the post op period, however, we have had much discussion about this and I have been told that these services are outside of the work RVU's and not part of normal recovery and therefore billable. Appreciate any comments on this. Thank you.

V. Kratzer,CPC, CGSC

 

[davidskm]

I was under the same problem and with discussion with other workers it was brought to our understanding that debridements can only be billed out with the attached Modifier 78 and they have to be taken to a procedure room/op room in order for the services to be billed, other than that they are bundled into the postop time and therefore paid within the payment for the surg.

 

[mitchellde]

The 78 modifier is for UNPLANNED return to the procedure or operative room. Go to appendix A of the PT book for your complete modifier descriptors. 58 would be the modifier for the anticipated/planned debridements following an amputation. Also I have never had an issue with Medicare or any other payer when this modifier is appropriately used. However if you use the wrong diagnosis code then it will not work.