ED Coding and Reimbursement Alert

Question: Six days ago, our physician saw a patient for drainage of a complicated abscess on his back. Today, the same patient presented with a severe headache and was treated by the physician. Can I code the second visit separately, or is it included in the global period for the abscess drainage?

Wisconsin Subscriber

Answer: Report 10061 (Incision and drainage of abscess [e.g., carbuncle, suppurative hidradenitis, cutaneous or subcutaneous abscess, cyst, furuncle, or paronychia]; complex or multiple) for the draining of the abscess. For the second visit, report the appropriate-level E/M code from the 99281-99285 series (Emergency department visit for the evaluation and management of a patient, which requires three key components ...) with modifier -24 (Unrelated evaluation and management service by the same physician during a postoperative period) appended.
 
The abscess drainage had a global period of 10 days, but the second visit was unrelated to the drainage and therefore not under the global-procedure umbrella. Appending modifier -24 to the E/M code informs the payer that the visit during the postoperative period was unrelated.