Wiki I&D during Aspiration Global Period

[erickalm]

A patient is seen in a clinic for abscess on his lower back. Provider does an aspiration 10160 and prescribes Bactrim. Four days later he comes back for a recheck and provider discovers the abscess has grown. The patient is forwarded to the center's Emergency Dept for an I&D 10060 on the same abscess completed by a different provider.

My question is, because the I&D is being performed on the same abscess but still during the global period of the aspiration, how do I code this?

Do I code both the E&M for the ED modifier 25 and the I&D along with the surgical tray because it is being completed in a different location with a different provider?

Or because it is within the same medical center, is the I&D inclusive with the aspiration global period even though it is a different procedure?

What does global periods include?

I was thinking of using mod 78, or 79 but it states 'the service by the same physician'. Does that include physicians within the same clinic? Or the same individiual physician?

Please help and please state source of info if possible!

Mahalo!

 

[OCD_coder]

There isn't enough information to give you a good answser. From you description, the patient was sent to the ER and possibly another procedure was performed by a physician other than your physician, who was the surgeon who performed the 10160.
The ED physician, which does not appear to be your physician would be able to bill for an E&M and a procedure if performed as they are not the surgeon who performed the 10160.

Also, you did not state who the insurance was for the patient and if the patient was MCR or MCD then the performing physician for the 10160 can bill nothing. The patient must return to the OR.

The 10160 has a global period of 10 days. So an additional course of treatment would be billable if documented correctly by the physician that performed the 10160, but not for MCD/MCR patients.

If your physician did not perform a procedure or a separate E&M and simply sent the patient to the ER, there possbily would be nothing to bill. Some clarification here would be helpful.

I have included an excellent link for a global surgical package Fact Sheet by CMS. It may help you figure out what is billable in this situation.

http://www.uthouston.edu/dotAsset/1f8ac0da-6fa7-423c-8c0e-cf7cb490a285.pdf