Neurosurgery Coding Alert

Check with your payer and append correct modifiers. If you’re assuming you always include postsurgical infection care in your primary procedure’s global surgical package, you could be leaving legitimate reimbursement on the table for these services. Follow these tips to determine when you can rightly report the post-op infections. Tip 1: Distinguish Between Medicare and Non-Medicare Patients Medicare treats postoperative complications, including infections, differently than insurers who follow CPT® guidelines. Although both CMS (Medicare) and CPT® guidelines indicate that the global surgical package includes "typical" postsurgical care, the two sources differ regarding what qualifies as typical -- which means you must differentiate your claims depending on which payer you are coding for. Medicare requires that a complication be significant enough to warrant a return to the operating room before you may report a separate procedure in the global period. In fact, CMS "Correct Coding" guidelines specifically state, "When the services described [...]