Neurosurgery Coding Alert

Question: A patient underwent L4/5 diskectomy and was discharged on the third day following surgery. On the seventh day, the patient was readmitted with an infection. May we bill for the H&P at readmission or is it covered under the global service?

Louisiana Subscriber  
Answer: According to Medicares Global Surgery Policy (S-99A), the approved amount for surgical procedures includes all additional medical or surgical services required of the surgeon during the postoperative period because of complications which do not require additional trips to the operating room. In this case, Medicare will not reimburse for medical services rendered during the global period. Reporting an E/M code for the history and physical will be denied. However, payers that follow CPT guidelines should allow this. Use an appropriate ICD-9 code for the infection and append modifier -24 (unrelated evaluation and management service by the same physician during a postoperative period) to the E/M code.
 
If the surgeon takes the patient to the operating room for an incision and drainage or debridement of the wound, you may report the appropriate procedure code for the secondary surgical procedure with modifier -78 (return to the operating room for a related procedure during the postoperative period).
 
Clinical and coding expertise for You Be the Coder and Reader Questions provided by Eric Sandham, CPC, compliance educator for Central California Faculty Medical Group, a group practice and training facility associated with the University of California at San Francisco in Fresno.