Wiki General Surgeon visit during Global-HELP PLEASE

[AR2728]

This is a frequent occurance with a particular surgeon in our practice--I need some advice. I've provided 2 examples:

Patient is within 10 day global period to a lesion excision. The doc notices patient developed atopic dermatitis due to bandage adhesive. The note is completely related to the lesion follow up with the exception of the following statment located in the Assessment/Plan: Patient does have significant rash where the stick-um of his band-aids were over his buttock. This is itching and I have recommended that he treat this with hydrocortisone cream topically twice daily and avoid band-aids. Is this enough documentation to warrant an E&M with a 24 modifier? If so, when calculating the E&M level do I consider the complete note, even though the rest of the note is routine global care?

Here is another example, same issue: within 10 day abscess I&D-note related completely to global follow up with exception of: HPI:...having diarrhea with three to four loose watery stools a day without blood or mucus, bloating or cramps, bloody or black stools. Assessment/Plan 3. Diarrhea. Patient has not started lactobacillus as instructed. Will check a C. diff sample and if positive, treat with Flagyl. Will stop his clindamycin as his cellulitis has resolved, and he has completed approximately a five day course. He is to start fiber and lactobacillus and call if this is not improving. Check a C. diff level.

 

[FTessaBartels]

Medicare or not?

First, if the patient is covered by Medicare you will not be able to bill either visit. Medicare will not pay for any E/M for complications of surgery (and follow-up treatment).

If the patient is NOT covered by Medicare. The documentation for the UNRELATED service must stand alone.

So I would say that what you've reported as the documentation in scenario 1 would NOT be sufficient.

Scenario # 2 is different in that it is unclear what the cause of the new symptom/complaint is and cultures are being ordered, etc. I would consider an E/M with modifier -24 in this case.

Hope that helps.

F Tessa Bartels, CPC, CEMC

 

[AR2728]

Much appreciation to you!