Wiki post op complication

[sdorsey]

I have patients that have a procedure or a delivery and return to the hospital for post op complications, for instance wound infections. I bill the approciate hospital E/M and sometimes it will be denied. Is there a modifier that can be used?

 

[amjordan]

Check your payer policies

You need to be aware of your payer policies. Some payers have adopted the Medicare policy that treatment of complications are included in the global unless they require a return to the OR. When it comes to complications during the post-partum period you can have the same payer issues. Even though CPT says you can bill them, most payers have different policies.

 

[sdorsey]

Makes perfect sense.
Thank you so much!!

 

[FTessaBartels]

Modifier 24

You want to use modifier -24 for all services in the post-operative global period that you feel are NOT inclusive to routine postoperative care.

But, as everyone has already said, it will depend on the payer whether they agree with you and pay. Many (more and more each day it seems) are following Medicare's lead and not covering anything that does not require a return to the OR.

Good luck

F Tessa Bartels, CPC, CEMC