Wiki Postop complication treated in office

[sjmccarl52]

We have a situation where during postop follow-up days, the patient develops an abscess which needs I & D and packing placed. Our physician wants to bill for the procedure using modifier 58. I don't think that is right since this wasn't "anticipated". What would be the proper modifier or is this just postop followup and can't bill additionally?

 

[ARCPC9491]

Use 78 - unplanned return to OR/procedure room by same physician following initial procedure for a related procedure during the postoperative period.

Complications aren't "routine" postop care. Yes, they do happen, but it requires additional work, time, and resources. They are codable with appropriate modifiers.

Now, from the billing end ... you may receive a denial but I encourage you to appeal. I've had payers go both ways, and it never hurts to try