General Surgery Coding Alert

Question: When a patient is having feeding problems following major surgery, can the surgeon bill for hospital visits for the TPN even though it’s within the global period? If so, what CPT and ICD-9 codes should we report?

Texas Subscriber

Answer: Under some circumstances, you may be able to separately charge for your surgeon’s patient visits related to total parenteral nutrition (TPN) for the patient with feeding difficulties.

Not for complication: If the feeding difficulties are a complication of surgery, you can’t separately bill Medicare or some other payers.

However, if it’s not for a complication and you have good documentation, you should be able to bill your surgeon’s additional services. Choose an appropriate E/M code such as 99231 (Subsequent hospital care, per day, for the evaluation and management of a patient …)

You’ll need to report modifier 24 (Unrelated evaluation and management service by the same physician or other qualified health care professional during a postoperative period) with the E/M code.

Regarding the ICD-9 code, without more specific information, the best code appears to be 783.3 (Feeding difficulties and mismanagement).