Wiki Injection during the post op period

[jessica1974]

I work for an orthopedic group and we often do injections during the global period. I have been using modifier 79 because it is unrelated to the procedure done during the global. Does anyone else agree that this correct? To me, 78 would be used if the patient is having a complication from the surgery. I know we can also use the 58 but most of the time the injection is not planned. Thanks for the insight.

 

[Orthocoderpgu]

What kind of injections are you talking about?

I code for three ortho clinics and it's not common to do injections during the global period. What injections are you speaking about?

Occasionally you will have a patient with so much pain during the post op that they will need an injection. Using -79 would be appropriate since it's not a return to the OR or staged (-58). But this should not be a common occurrence.

 

[daedolos]

If the injection is for pain management at the same site of the surgery then wouldn't there be an automatic denial of the claim?

Peace
@_*
It happens on occasion that during a post-op service that the patient presents with a new complaint and the doctor decides to assess the new problem and do an injection but it's for a different site/problem. Depending on the documentation, I use the following:

99212/99213-24
CPT Code - necessary modifier
Supply Code

 

[Orthocoderpgu]

The injection should not deny

If the injection is for pain management at the same site of the surgery then wouldn't there be an automatic denial of the claim?

Peace
@_*
It happens on occasion that during a post-op service that the patient presents with a new complaint and the doctor decides to assess the new problem and do an injection but it's for a different site/problem. Depending on the documentation, I use the following:

99212/99213-24
CPT Code - necessary modifier
Supply Code

If an injection is done during the post op period, this is usually a sign that the patient is not progressing as they normally should. As time goes on the patient should get better and experience less pain. However if they are experiencing enough pain that they receive an injection, this is a complication of the procedure and is paid separately. I bill these with a -79 modifier and they are paid as a complication.

 

[thomas7331]

If an injection is done during the post op period, this is usually a sign that the patient is not progressing as they normally should. As time goes on the patient should get better and experience less pain. However if they are experiencing enough pain that they receive an injection, this is a complication of the procedure and is paid separately. I bill these with a -79 modifier and they are paid as a complication.

CMS guidelines specify that treatments of complications in the global period are not paid separately unless they require a return to the operating room - based on this guidance, I don't believe a 79 modifier is appropriate for a complication, although some commercial payers may have policies that do allow this.

What services are included in the global surgery payment?
Medicare includes the following services in the global surgery payment when provided in addition to the surgery:
...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?
The following services are not included in the global surgical payment. These services may be billed and paid
for separately:
...Clearly distinct surgical procedures that occur during the post-operative period which are not
re-operations or treatment for complications

 

[daedolos]

If an injection is done during the post op period, this is usually a sign that the patient is not progressing as they normally should. As time goes on the patient should get better and experience less pain. However if they are experiencing enough pain that they receive an injection, this is a complication of the procedure and is paid separately. I bill these with a -79 modifier and they are paid as a complication.

I was told in this office, prior to my arrival, that after too many claim denials that they instituted a policy of not billing for complication pain management. I wasn't aware I could've used the -79 modifier. This is something to consider. Thank you.

Peace
@_*

 

[NMURPHY8366]

You do not want to use modifier 79 if injection was done in office during post op period. If its not a return visit to the OR then its not covered. If Medicare or any other payer is paying it that way, eventually they will do an audit and ask for reimbursement on those. I know from experience. Read below from Medicare



What services are included in the global surgery payment?
Medicare includes the following services in the global surgery payment when provided in addition to the surgery:
...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?
The following services are not included in the global surgical payment. These services may be billed and paid
for separately:
...Clearly distinct surgical procedures that occur during the post-operative period which are not
re-operations or treatment for complications