General Surgery Coding Alert

Answer: Medicares global surgical package includes all complications in the postoperative period, except those that require a return trip to the operating room. All office visits that are related to the surgery also are included in the global surgical package and are not separately payable. Consequently, the only service in the subscribers example that may be billed is the return to the operating room for the incision and drainage of the abscess, with modifier -78 (return to the operating room for a related procedure during the postoperative period) attached, which indicates that this is a return to the operating room for a complication of the original surgery, says Susan Callaway-Stradley, CPC, CCS-P, an independent coding consultant and educator in North Augusta, S.C.

Codes 26990 (incision and drainage, pelvis or hip joint area; deep abscess or hematoma), 10180 (incision and drainage, complex, postoperative wound infection) and 54700 (incision and drainage of epididymis, testis and/or scrotal space [e.g., abscess or hematoma]) are all possible incision and drainage codes in this scenario, depending on where the abscess was, which should be determined by reading the operative note.

Note: Unlike Medicare, some commercial payers will pay for evaluation and management (E/M) services to treat postoperative complications. Check with your carrier before transmitting or sending the claim.