Wiki Nursing Home - Removal

[maryscalf]

One of our family medicine providers went to the nursing home to do a removal. A nurse assisted with the procedure due to the patient having dementia and potential combativeness. The physician returned to remove the stitches 7 days later. Is there any additional coding due to the assistance of the nurse? And even though the stitch removal is at the facility location would it still be considered under the global period? Any help would be appreciated.

Thanks!

 

[Pam Warren]

Removal of what? LOL!

You can't code additionally for the nurse...she's an employee of the nursing home, and that's reimbursed to the nursing home by Medicare. But you can try to put a -22 on the removal code, but you'd have to have very good documentation in regards to why it was a difficult procedure. I wouln't hold my breath for additional reimbursement on a minor surgery, though.

The stitch removal is bundled into the global (I'm guessing 10-day). Make sure you code the POS as nursing home when you code the 'removal', but be aware that some procedures (such as wound care) are not reimbursed by CMS when done in a nursing home. You have to bill the nursing home, which requires a contract with them. Since you didn't tell us what was removed, I can't be sure if CMS will cover it when done at the NH.