You Be the Coder:
Aspiration During Global Period
Published on Fri Nov 01, 2002
Test your coding knowledge. Determine how you would code this situation before looking at the box below for the answer.
Question: After mastectomy, there is sometimes a build up of fluid that needs to be removed, sometimes for weeks afterward, via aspiration. Is this included in the global period of the mastectomy, or can we bill aspiration separately with modifier -58?
Michigan Subscriber
|
Answer: The answer depends primarily on your payer. For Medicare, postoperative complications that do not require a return to the operating room (OR) are included in the global period of the original procedure and are therefore not separately billable.
Many (but not all) non-Medicare payers take a different view consistent with CPT guidelines that significant postoperative complications do not qualify as "typical postoperative care" and therefore dealing with such complications, in either the OR or the office, is not included in the global surgical package.
By this reasoning, you may report the drainage separately using drainage code 10140* (Incision and drainage of hematoma, seroma or fluid collection). For carriers other than Medicare, append modifier -79 (Unrelated procedure or service by the same physician during the postoperative period) for complications that don't necessitate a return to the OR. Do not append modifier -58 (Staged or related procedure or service by the same physician during the postoperative period) because this would suggest that the drainage was planned prospectively at the time of the original procedure. | |
