Outside of the Global Surgical Package?

[1071471]

Hi everyone, I am unsure if this should be coded outside of the global period so I thought I would get 2nd and 3rd opinions...(especially since it's a medicare patient) It doesn't seem like normal post op recovery, but then again it's medicare...

S/P Abdominoperineal resection of the rectum on post op day #3 (same hospital visit) overall hemodynamically stable but develops a fever with infiltrate on chest X-ray. Started patient on antibiotics and R/O pneumonia, checking lab values, so far uncontrolled

Thoughts??

 

[Belinda Frisch]

Yes.

I'd say outside of the global surgical package and bill 99231-99233 with modifier 24. The global package covers things that "are routinely part of the follow up and recovery from surgery"; I'd say the lung infiltrate is not related to the surgery though the fever could be part of an infectious process. Use the lung diagnosis primary.

 

[FTessaBartels]

Mod 24

I agree, if your surgeon is actually treating the pneumonia. If the surgeon is merely listing it as something that is occurring with the patient (but the pneumonia is being treated by Hospitalist, for example), then you would not code for it.

We just had a sample of this, where baby had major surgery for gastroeschesis. On post-op follow-up visit the surgeon noted the child was positive for MRSA. That's all ... nothing else. We did not code that visit with a -24 modifier. And when I asked the surgeon (to be certain), she told me she would never treat the infection, that would be treated by the Neonatologist or Infectious Disease specialist; she would, however, record it in her progress note because it was an important medical fact in this child's recovery period.

Hope that helps.

F Tessa Bartels, CPC, CEMC