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cmort68

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Good Afternoon,I have a patient that is in a 90 day global for LT ankle fracture S/P ORIF, presents to the ER and the surgeon (my provider) who completed the surgery completes ER visit for dehiscence of the surgical wound and next day completes hardware removal. My question is this, can I bill any type of ER E/M while in the global or does it get coded as a 99024??? Any thoughts would be appreciated!!!
 
Hi CMort68
Yes I'd bill it again with valid EMR CPT code 99283 because the dehiscene or incision split open. This might cause infection and is a a new problem. I d add dx T81.32XA . If no problem with surgery use 99024 as free follow up. New problem then code and bill it.
I hope this helps you
Lady T
 
Take in to account who the payer is.

Here are a couple references but please be aware of the date of publication:



Specifically from this MLN article:
Medicare includes the following services in the global surgery payment when provided in addition to the surgery: • All additional medical or surgical services required of the surgeon during the post-operative period of the surgery because of complications, which do not require additional trips to the operating room.
What services are not included in the global surgery payment? The following services are not included in the global surgical payment. These services may be billed and paid for separately:
• Visits unrelated to the diagnosis for which the surgical procedure is performed, unless the visits occur due to complications of the surgery. • Treatment for post-operative complications requiring a return trip to the Operating Room (OR). An OR, for this purpose, is defined as a place of service specifically equipped and staffed for the sole purpose of performing procedures. The term includes a cardiac catheterization suite, a laser suite, and an endoscopy suite. It does not include a patient’s room, a minor treatment room, a recovery room, or an intensive care unit (unless the patient’s condition was so critical there would be insufficient time for transportation to an OR).
 
The patient has Medicare of Wisconsin, but it is related to the removal of the hardware due to infection, so I then can bill an ER E/M because the infection is due to the hardware and there was a return trip to the OR.
Thanks you guys for responding, in the 2 years I have coded Ortho, this is the first time this has happened :) Would I need a modifier for the E/M for the visit prior to surgery the next day??? I have applied the 78 modifier for the 20680 for removal the next day to indicate unplanned return during Post Op period.
 
cmort68 said:
The patient has Medicare of Wisconsin, but it is related to the removal of the hardware due to infection, so I then can bill an ER E/M because the infection is due to the hardware and there was a return trip to the OR.
Thanks you guys for responding, in the 2 years I have coded Ortho, this is the first time this has happened :) Would I need a modifier for the E/M for the visit prior to surgery the next day??? I have applied the 78 modifier for the 20680 for removal the next day to indicate unplanned return during Post Op period.
Click to expand...
My opinion is the visit was due to a complication of the surgery and is included in global per Medicare guidelines (AMA guidelines differ). If the ER visit was unrelated or additional treatment of the underlying condition, then it would be billable.
The additional treatment/procedure done in the OR is billable with -78 as you indicated.
 
I agree with csperoni, if MCR you can't bill the ED visit (global). The ED room does not count as an OR by their definition above. You can bill the surgery w/ 78. This is always a debated topic.
 
cmort68 said:
So, I should not bill an E/M for the ER visit due to being global, MCR? Do I use 99024 for that visit then?
Click to expand...
Yes, and in some states for Medicare (MCR) 99024 was required to report even though it's $0. However, that was knowledge from a few years ago and I am no longer working in provider coding so I'm not sure if that's still the case. I would not recommend billing it in my opinion.
 
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