Need some opinions, PLEASE.

solocoder

Expert
Messages
421
Location
Marshfield, MO
Best answers
0
Is there any way this debridement is billable to Medicare, and not considered a complication? Is there something I'm missing? Or something the doctor could clarify?

Patient had a toe amputated. Post op visit reads:

Left great toe amputated. Fibrous slough noted to wound base. Upon debridement of amputation site ulcer with fat layer exposed measuring 1.5x 0.8 x 0.2 cm noted. Healthy bleeding noted on debridement. No erythema noted. No malodor noted. Mild edema noted to foot. Able to dorsiflex, plantarflex, invert, and evert foot without difficulty. Skin temperature is warm to palpation. Strong DP pulse noted.
*
Debridement:
Type- ( x ) Excisional ( ) Non-excisional
Instrument- ( x ) Scalpel ( x ) Scissors & Forceps ( ) Curette
Tissue removed- ( x ) Skin ( x ) Subcutaneous ( ) Muscle
Appearance- ( x ) Fresh bleeding tissue ( x ) Viable tissue
Nature of tissue removed-- ( x ) Slough/biofilm ( x ) Non viable tissue ( ) Necrosis
Size- Pre 1.4 cm x 0.5 cm x 0.1 cm Post 1.5 cm x 0.8 cm x 0.2 cm
Depth- ( ) Limited to breakdown of skin (x ) Fat layer exposed
( )Necrosis of muscle ( ) Necrosis of bone
 

avon4117

Guru
Messages
246
Location
FLINT
Best answers
0
my thoughts were if bleeding occurred during surgery and had to be repaired then it is not billable..maybe someone else can weigh in?
 

thomas7331

True Blue
Messages
3,162
Best answers
10
I agree - complication or not, if this is post-operative care in the global period being done by the same physician who did the amputation, it falls into the global package and can't be billed.
 

solocoder

Expert
Messages
421
Location
Marshfield, MO
Best answers
0
Sounds reasonable to me, and it would make my life much easier to bundle it. But the sticking point for my doctor is under "what is not included" in a global package it says: Treatment for the underlying condition or an added course of treatment which is not part of normal recovery from surgery. He feels this is an added course of treatment not part of normal recovery from surgery.
Any suggestions of how I can argue with that?
Appreciate the advice.
 

cgaston

Expert
Messages
494
Location
Clarence, NY
Best answers
0
Funny how they skip right over the "return to the operating room" part, huh? :eek:

I show my Providers the Guidelines...no return to the OR, not separately billable. Good luck!!!
 

thomas7331

True Blue
Messages
3,162
Best answers
10
He is correct about the rules, but his documentation does not reflect that this service is for any underlying condition or that it is not a complication related to the surgery. He is documenting debridement of the surgical site with no mention of any other condition or factor that would support separating this from the global package. I always ask myself if I would be able to write an appeal letter to support a coding decision and I can't think of any way that I would be able to write a good defense of it for this particular note.
 
Top