complications of excision

cmac

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does anyone know how or if you can get paid for a complication of a procedure? we had a patient who had an excision 6 days ago, so she's still in the 10 day global period, came in today for a nurse visit and has an infection to the excision site. is there a special way to code this to ensure it's paid? does anyone have any tips to getting these paid?
 

Treetoad

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Per Medicare guidelines, unless a patient is taken back to the OR, the visit would be considered part of the global period. However, some insurance carriers don't follow Medicare guidelines and would pay for an E&M service with modifier 24. Of course, documentation would need to support the E&M service. You may want to contact the patient's insurance carrier to know for sure how they handle complications.
 
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