Wiki Final post op visit with complications

[cherylbr]

Can I please have your opinion.......

Patient underwent surgery and has now presented to the office for his final post operative visit. He has now developed cellulitis around his incision and the need for hospital admission for IV antibiotics, etc.

Since the patient in still within his global period and this appears to be a related complication of his surgery, is then anything other than a post operative visit you can bill?

Thank you!

 

[MI_CODER]

If the patient is still within a global period then the E/M visits for the complications are not billable. If the patient has to return to the operating room then you could code the procedure(s) with a modifier 78. Modifier 78 does not restart the global period.

What services are included in the global surgery payment?
• 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.

What services are not included in the global surgery payment?
• Treatment for post-operative complications requiring a return trip to the Operating Room (OR). An OR, for this purpose, is defined 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 patient’s room, a minor treatment room, a recovery room, or an intensive care unit (unless the patient’s condition was so critical there would be insufficient time for transportation to an OR).

Inappropriate Usage of Modifier 24
• Do not use when the E/M is for a surgical complication or infection. This treatment is part of the surgery package.
• Do not use unless the medical record documentation clearly indicates the E/M was unrelated to the surgery.

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