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Wiki Hospital admit during global period

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VIOLYNPLA2

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Chesapeake, VA
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Hello all,

My orthopedic physician has readmitted a patient to the hospital after developing cellulitis following a total knee replacement. This is a complication of the original procedure but he wishes to bill initial hospital care. So there is a discussion as to whether this complication is "of the norm" and considered part of the global service. No other surgical procedure will be performed only IV antibiotics. Please provide your input on this situation. What do you say?
is the e/m for the readmission billable or not?

Thanks:rolleyes:
 
I would code for the E/M with the 24 modifier with the infection/cellulitis diagnosis code. It is not "normal" for patients to be readmitted after a total knee for infection. If it gets denied, I would appeal it.
 
If the patient has Medicare, this admission would still be considered global. CMS guidelines indicate that unless the patient is taken back to the OR, the service is part of the global surgical package--even for the complication. CPT guidelines are different from CMS, so other carriers may pay for the admission. You would probably want to contact the payor.
 
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