Wiki Postoperative care/billing

[TanBro]

Quick question, patient had a TLh done in an outpt surgery center, 2 hours into po care she had some complication involving circulatory system and was taken to the hospital for observation. Can you tell me if I can bill for the hospital observation with E/M or is it bundled with the outpt surgery. She was there 2 days.

 

[thomas7331]

Under Medicare policy, E/M services related to complications of a procedure are included in the surgeon’s global package and not separately billable.

 

[TanBro]

Under Medicare policy, E/M services related to complications of a procedure are included in the surgeon’s global package and not separately billable.

Ok that's what I was thinking but I thought I better check to make sure. I think the different facility was throwing me off. Thank you so much for your fast response.

 

[TanBro]

Under Medicare policy, E/M services related to complications of a procedure are included in the surgeon’s global package and not separately billable.

Would I be able to throw a 22 modifier on this at least? She was in the hospital for 2 days after the original surgery.

 

[nielynco]

Would I be able to throw a 22 modifier on this at least? She was in the hospital for 2 days after the original surgery.

No. The -22 is used when the surgery was more difficult. However, Medicare does allow for observation after an outpatient procedure if it is over and above what would be expected for the surgery involved. But the patient must have a problem, not be put in observation to ensure a problem does not develop. If the patient had been admitted to inpatient care for this complication, there would be no problem. The issue is observation which can be up to 24 hours per Medicare and therefore included. If you exceed that they will allow billing with documentation. As this problem may not be related directly to her surgery, I would try billing and see what happens.

 

[TanBro]

No. The -22 is used when the surgery was more difficult. However, Medicare does allow for observation after an outpatient procedure if it is over and above what would be expected for the surgery involved. But the patient must have a problem, not be put in observation to ensure a problem does not develop. If the patient had been admitted to inpatient care for this complication, there would be no problem. The issue is observation which can be up to 24 hours per Medicare and therefore included. If you exceed that they will allow billing with documentation. As this problem may not be related directly to her surgery, I would try billing and see what happens.

Thankyou!! I will try. She had postoperative surgical complication involving circulatory system. Developed bradycardia and hypotension. It was observation so I used the observation codes with modifier 24. (Surgery was done in December)