Wiki Wound Care after EXCISION PILONIDAL CYST/SINUS COMPLICATED

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kschulte71

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Patient was seen in our OR for EXCISION PILONIDAL CYST/SINUS COMPLICATED. The patient follows up weekly for wound care treatment. The wound clinic is in the same hospital as the OR and is being done by the same physician. The note states:
"HPI: Patient presents to office for followup wound care. Silver aginate in place to sacral wound. Medihoney in place to midline and left of midline wound. Patient states his drainage has improved. Pain is less per patient, overall he is improving.
Assessment & Plan: Post op wound management to surgical wound sites. Switched plan of care: Placed medihondy with tegaderm dressing to lower midline wound. Upper Midline and left of midline placed medihoney with opsite". I am billing a 97602 x3 (3 wounds) for the facility charge.

We are billing an E&M level for the Professional charge but it is getting denied for Global to surgical procedure. Code 11772 has a RVU Global Days of 90. The surgeon feels this should not be considered global due to the the wound care is above normal routine care. Can anyone assist me in determining if this truly should fall under an exception to be billed or is it considered Global?
 
The care is above and beyond normal postoperative care (which is why the 97602 should be payable) but the reason for the visit is "followup wound care" (post op wound management to surgical wound sites) which is related to the surgery.
 
The 97602 is being paid for the Facility claim. But because it is not billable as a professional code, they coded with the 99213 which is being denied due to Global. What recommendation should I give the physician to document so that it states it is beyond normal postoperative care.
 
kschulte71 said:
The 97602 is being paid for the Facility claim. But because it is not billable as a professional code, they coded with the 99213 which is being denied due to Global. What recommendation should I give the physician to document so that it states it is beyond normal postoperative care.
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According to Novitas and Palmetto GBA, 2 of the MCR MACs any post op complication/treatment due to the surgery is considered part of the global package.
CMS has the following article:
https://www.cms.gov/Outreach-and-Ed...oducts/downloads/GloballSurgery-ICN907166.pdf

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I also code for wound care done by our general surgeons. They do not like that this falls into a global, either. However, the complications from a surgery, unless you can prove they are not related, do fall under the global package from everything I have read.
 
What if a surgeon billed 11772 and within the 90 global period referred the patient to our provider who is a wound care specialist and we billed 99204 (25mod), 11042(59 mod), and 11045 and now our claim is denying for global. Since we are not the physician who did the surgery can we bill for these services within the global period?
 
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