Tuft amputation global period question

[lbaker105]

I have an tuft amputation code of 11752 with a debridement 11012-51.

Pt. came in as an urgent care/middle of the night/ next day came back and the sutures were taken out and then skin was trimmed down and re-sutured. Can I bill for second procedure and do you have any recommendations?

Thanks for any help.

[PLAIDMAN]

If your doc is the doc who performed the surgery in the urgent care clinic, then he cannot bill for the follow up care.

If you doc is not the doc who performed the surgery, then I would bill the surgical codes with a 55 mod postoperative management only. The urgent care should have billed with a 54 mod knowing the patient would not follow up with them.

[lbaker105]

The doc knew that he was going to revise the primary repair. I thought maybe this would be billed with a staged procedure modifier.

[PLAIDMAN]

Ewwww. Staged is so sticky. What I know about staged is that it has to be set up in the original op note that further procedures are going to need to be done.... and there needs to be medical necessity-why did he need to revise it? I have found that payors are not interested in paying for cosmetic purposes- So if your doc did it strictly for cosmetic purposes, then maybe he should just consider himself a good doc. AND what code would you bill? Most possible codes I looked at required the use of anesthesia other than local, and again this is all assuming your doc did the primary procedure.

I don't know baby that's all I got.