Wiki Complication During Global Period

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klbrown1

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I'm posting this in Gen. Surg. and E/M forums since it's a little of both.

Medicare patient has lung cancer (162.9) and has a resection and segmentectomy (32504 and 32484) among other procedures with a 90 day global period. Approx 2 weeks later patient diagnosed with pneumonia (486) and seen several times by same surgeon as in-patient (99233) for treatment of pneumonia.

Can I bill these subsequent hospital days to Medicare? The pneumonia may not be a direct complication of the surgery, but rather a complication of being in the hospital altogether. Are the dx's different enough to be considered non-related?

If I can (or can't) - can you please give a link to whatever documentation you get your answer from?

Thanks,
 
Nosocomical complications are tough to bill. Is that specifically documented or implied? which may be a moot point when considering the following...

Check out the Medicare Claims Processing Manual, Chapter 12, section 40 Surgeons and Global Surgery. Or you can type in "global" in the search area on the top bar to find all occurances of the word "global" in the document.

http://www.cms.gov/manuals/downloads/clm104c12.pdf

I hope this helps.
 
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Thanks for the post.

I'm leaning toward it being billable because the link you gave me says "Visits unrelated to the diagnosis for which the surgical procedure is performed, unless the visits occur due to complications of the surgery" under the separetely payable heading and "Postoperative Visits - Follow-up visits during the postoperative period of the surgery that are related to recovery from the surgery" under the inclusive heading.

The pneumonia was "unrelated to the diagnosis for which the surgical procedure is performed". The surgery was definetely not performed due to pneumonia. The patient may have been more susceptible to the pneumonia due to her post surgical status, but she may have contracted the pneumonia no matter what reason she was in the hospital (even a visitor), so I don't think it is considered "related to recovery from the surgery".

Anyone else agree/disagree with my opinion?
 
I would have to agree with you. Trying to determine what is normal and uncomplicated post operative care can be tricky. I code for general, vascular and thoracic surgery and wound care. I know that Medicare assumes that you will have a certain amount of post operative complications. It is a tough call sometimes. I usually go on the side of caution unless the documentation really does stand alone and not related to the reason for the surgery in the first place.

Susie Smith, CPC
 
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