Wiki Help! - ortho surgeon performs

[kandigrl79]

Okay, so...an ortho surgeon performs an arthroscopic procedure on a patient (one which carries a 90 day global period). Two days later he presents to the ED with hemarthrosis. The ortho on staff in the hospital refuses to see the patient, and the attending in the ED doesn't feel comfortable doing an aspiration. So the same ortho surgeon (which is who I work for) that performed the initial procedure, evaluates the patient and does an aspiration. He feels that he should code 99242, 20610 -78. I think that he should only get 20610 -78 because the patient is in the postoperative period and any evaluation and management services performed in relation to that initial procedure (due to complication or otherwise) should be included in the global package. Thoughts????

 

[ajs]

Okay, so...an ortho surgeon performs an arthroscopic procedure on a patient (one which carries a 90 day global period). Two days later he presents to the ED with hemarthrosis. The ortho on staff in the hospital refuses to see the patient, and the attending in the ED doesn't feel comfortable doing an aspiration. So the same ortho surgeon (which is who I work for) that performed the initial procedure, evaluates the patient and does an aspiration. He feels that he should code 99242, 20610 -78. I think that he should only get 20610 -78 because the patient is in the postoperative period and any evaluation and management services performed in relation to that initial procedure (due to complication or otherwise) should be included in the global package. Thoughts????

A consultation code would not be appropriate anyway, no one asked for his opinion. He could code for the evaluation in the ER using 99211-99215 with a 25 modifier and then the aspiration with the 78 modifier. Even though the patient is still in the global post op, it is a complication that had to be evaluated so the E/M can be reported.

 

[kandigrl79]

His opinion actually was asked in this case, that's the part of the story that I left off. The patient was transported to a different ED (after the attending and ortho at the initial refused to touch him) and there, our ortho was contacted for a consult. But thanks for your response. My billing manager has chosen not to bill E&M. I wouldn't think a 25 would work anyway as it doesn't address the postoperative status, it just differentiates the E&M from the surgery with which it's being billed. A 24 does address the postoperative status, but it states "unrelated," so I didn't feel it would be appropriate in this case either. But, as it turns out...it's all moot Thanks again for all your help.