Wiki Post Op Follow Up

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Licorice5

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If a patient comes in for follow up during the post op period and during this visit it is apparent the surgery did not solve the problem and now amputation is required. A lengthy discussion regarding this and the risks and benefits of the surgery is included in this post op visit. Can it now be billed? If so, suggestion on the modifier?

Thanks for any assistance.
 
Payer dependent

As always, I would need to actually see the note to tell for certain .... however, here is some food for thought.

If the patient is covered by Medicare, I don't think you'll be able to bill the visit. Complications are not covered by Medicare, except for procedures requiring a return to the OR.

If the patient is NOT covered by Medicare .... many commercial payers would accept a -24 modifier for a serious complication, as it is not routine postoperative care. If the amputation is going to take place within the next day or two I would also add a -57 modifier for the decision for surgery.


Hope that helps.

F Tessa Bartels, CPC, CEMC
 
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