Hospital Care Codes during Surgery global period

ELBrock

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Hello! Here is the scenario I'm hoping to get some assistance on:
- Patient underwent a Laparoscopic Assisted Vaginal Hysterectomy by Provider A in the hospital. (there is a 90-day global period)
- 11 days later, the patient presents to the ED with rectal bleeding, and is diagnosed with an Abscess. Provider B, of the same group/specialty as Provider A, admits the patient to the hospital.
- The patient is in the hospital for three days before she is scheduled for a CT-guided Drainage of the Abscess. Neither Provider A or B perform this procedure.
- Since the patient is within the 90-day global period of the hysterectomy done by our group, but IS returning for a procedure, then the procedure can be billed with modifier 78, but what about the three days of hospital care? Can our providers bill for this outside the global surgical package, or are these visits included in the payment for the procedure we performed 11 days prior, since the Abscess is a complication of the hysterectomy procedure?

Thank you for your input!
 

ELBrock

Networker
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Hi Twizzle. I have a query to the provider and am pending a response asking if the Abscess is a complication of the Hysterectomy. I am just thinking ahead to the next step. If the provider states it is not related, then I could bill those Hospital Care codes with Modifier 24, correct? And if it is a complication, then these services are not separately billable? Thank you!
 

twizzle

True Blue
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That is essentially correct. It seems to me that the abscess is unlikely to be a complication (but it could be) and so you would bill your E/M with modifier 24 and the abscess diagnosis.
Provider needs to clearly state this though.
 
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