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Old 01-13-2011, 12:27 PM
risnerclan risnerclan is offline
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Default injections during post op global period

I have a physician who did an injection 20610 due to post op knee pain during a post op period from a knee scope 29881. Can he bill the 20610 or is included as a part of the surgical package?

What i am looking for is if you can't actual documentation stating medicare does not allow it.

Thanks!

Carol
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Old 01-13-2011, 02:06 PM
PLAIDMAN PLAIDMAN is offline
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No you cannot charge for injection to same surgical site during global.

Post surgical pain management is part of the global surgical package.

You can find this information on the CMS website under the claims processing manual,chapter 12.

"All additional medical or surgical tx required of the surgeon during the postoperative period because of complications which DO NOT require a return trip to the OR" are included.

I would recommend you go to the website and print this, it is quite large, but, I cannot tell you how many times I have had to refer to it. It's worth printing.
I can fax you just the pages that refer to this.
Be careful too, because a lot of commercial payors have adopted this rule as well.
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Old 01-13-2011, 03:07 PM
risnerclan risnerclan is offline
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thanks for your help! I will help but do you mind faxing me the section i need. 501-604-3221 attention Carol

Thanks!
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Old 01-14-2011, 12:51 PM
risnerclan risnerclan is offline
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one more question...so changing of a cast is part of the surgical package...huge debate in our office...sorry!

Carol Risner
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Old 01-14-2011, 01:52 PM
PLAIDMAN PLAIDMAN is offline
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You cannot charge for initial cast application BUT you CAN charge for replacement casting.

So if pt has surg on 12.10.10 and is casted after surg on 12.10.10 you cannot charge for casting. When pt comes in for follow up 2 weeks later and you take cast off , take xrays, and apply new cast , you can charge for that cast with a 58 mod, as well as casting supplies.

As far as I know, of the payors I deal with, they all follow this guideline.

This is stated in the Medicare guidelines I faxed, it is on the second page of "B. Services not included in the Global surgical package". I believe there are also a few articles on this specific topic by AAOS, you can google.

Did your doc accept that documentation?
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Old 01-17-2011, 07:22 AM
risnerclan risnerclan is offline
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yes they did thanks so much for your help.

Carol
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