Wiki Cesarean Wound Dehiscence

[Jenetteis]

Patient is seen for first postpartum visit on day #22, s/p primary low transverse cesarean. Patient c/o small amount of yellow/pinkish discharge from incision site. denies odor or pain.

On PE, steri strips removed. wound dehiscence measuring 1cm at center of incision, area non-erythematous and not warm. only tender to palpation. tracking noted 7cm inside incision site to patient's right. purulent drainage noted. sample collected for culture. packed with 0.5" plain packing strip and covered with gauze dressing and paper tape.

Assessment/Plan: Return every day this week for wound packing changes.

Patient is seen the next 10 days for wound repacking with various physicians at the clinic. I am not sure what to code bill here.
Do I code an E/M (99211-215) for each visit?
Should I add 99024 (Post op f/u visit) for each visits with the physician who preformed the c-section?
What about 12021- treatment of superficial wound dehiscence, with packing?

Example:
POD1:
12021(10 FUD) - O90.0: Disruption of Cesarean Delivery Wound; T81.40XA: Infection following a procedure, unspecified, initial encounter
99212,24 - O90.0: Disruption of Cesarean Delivery Wound; T81.40XA: Infection following a procedure, unspecified, initial encounter
99024 - O90.0: Disruption of Cesarean Delivery Wound; T81.40XA: Infection following a procedure, unspecified, initial encounter
MISCGLOBAL - Z39.2: Encounter for routine postpartum follow-up
POD2:
99024 - O90.0: Disruption of Cesarean Delivery Wound; T81.40XA: Infection following a procedure, unspecified, initial encounter
Any assistance is appreciated. Thank you!

 

[csperoni]

Unless the wound required return to the OR, this is included in global per CMS guidelines. This is clearly a complication/related to the c-section. If the providers caring for her are ob/gyns part of the group that did the delivery, this is all included in postop care.
From the Medicare global surgery booklet https://www.cms.gov/outreach-and-ed...oducts/downloads/globallsurgery-icn907166.pdf page 6 excerpt below:
What services are included in the global surgery payment?
Medicare includes the following services in the global surgery payment when provided in addition to the surgery:
• Pre-operative visits after the decision is made to operate. For major procedures, this includes pre-operative visits the day before the day of surgery. For minor procedures, this includes pre-operative visits the day of surgery.
• Intra-operative services that are normally a usual and necessary part of a surgical procedure
• 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
• Follow-up visits during the post-operative period of the surgery that are related to recovery from the surgery
• Post-surgical pain management by the surgeon
• Supplies, except for those identified as exclusions
• Miscellaneous services, such as dressing changes, local incision care, removal of operative pack, removal of cutaneous sutures and staples, lines, wires, tubes, drains, casts, and splints; insertion, irrigation, and removal of urinary catheters, routine peripheral intravenous lines, nasogastric and rectal tubes; and changes and removal of tracheostomy tubes

Please note: CPT rules about billing complications may vary. All of our payors follow the CMS global surgery guidelines.
https://www.aapc.com/blog/24555-cms-vs-cpt/