Wiki tx wound dehiscence help please!

[TLC]

A patient came into the office 4/13/15 and had a lipoma removed from the trunk. He than returned 4/21/15 for a problem with the excision. The wound had opened up on one side. Sutures still in place. There was a blood clot coming out from the wound. The doctor a (different one, but same practice) spent 30-40 minutes removing the blood clot. She than closed just that open part of the wound with steri strips. Is this considered "up and above global"? I thought she could maybe charge a 12021 however this says with infection there was no infection just the clot. Can she charge anything at all maybe a E/M code since closed with steristrips or is there something else she could charge. Thank you.

 

[lmartien]

If the return to the office for the dehiscence treatment falls within the global period of the lipoma surgery then I might have to say 'no', this is a complication of the same surgery and would be included in the global period, even an E/M visit. Sorry :-(

 

[TLC]

I saw this under the guidelines.
Follow up care for Therapeutic Surgical Procedures.
Follow-up care for therapeutic surgical procedures includes only that care which is usually a part of the surgical service. Complications, exacerbations,recurrence or the presence of other diseases or injuries requiring additional services should be seperately reported. I think this would apply? Thanks

 

[Bready]

tx wound dehiscence

the debatable point would be "typical post-op care" for the procedure performed. I wouldn't think that removing a blood clot would be considered typical unless all lipoma- removal surgeries develop blood clots postoperatively. For commercial insurance I would file the claim(however you decide to code it) but send along the physician's notation of the presence of the blood clot and its removal(time spent; difficulty, etc). But if the patient has Medicare, the claim will probably be denied because it didn't require a return to the OR.
Good luck.