EM Coding Alert

Question: A patient presents for an evaluation and management (E/M) visit two-weeks following a septoplasty for a severe deviated septum. After a brief exam, the surgeon diagnoses the patient with postoperative septal abscess and prescribes the patient with an antibiotic. A follow up appointment is scheduled for one week. Can the provider bill out for this E/M visit for this Medicare patient?

Texas Subscriber

Answer: In this scenario, you may not bill for the E/M visit if the patient is presenting with symptoms related to the surgery. Since procedure 30520 (Septoplasty or submucous resection, with or without cartilage scoring, contouring or replacement with graft) has a global period of 90 days, any related E/M service within that time period is considered an included component of the surgery.

If the patient had presented for an entirely separate diagnostic reason from the procedure two weeks prior (unrelated nasal abscess, for example), the consultation would be billable with a modifier 24 (Unrelated evaluation and management service by the same physician or other qualified health care professional during a postoperative period). One would need to clearly document that this is a new diagnosis and unrelated to the surgical treatment for a deviated septum.

An alternative clinical scenario is the development of a postoperative abscess that the surgeon decides to remove. While the E/M service would not be separately reportable, if the surgeon opts for a follow-up procedure to remove the abscess or to simply remove residual scar tissue causing blockage, you could append modifier 78 "Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period" to the surgical code.

Consider:  While Medicare will not pay the for a related E/M service within the 90-day global period of the procedure, some other payers may. Depending on the complexity of the examination, the extent of work could exceed CPT^®'s global package definition of "typical postoperative care." Therefore, it's worth checking with a specific payer on the possibility of reimbursement.