A patient was admited to the hospital for complications from her surgery that she had 15 days earlier. 99253/24 was billed and the insurance denied it as inclusive. Was wondering if anyone had any modifier suggestions,or if this was even billable, or is included in the post op global period?
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Wiki post of complication question?
- Thread starter eferris
- Start date
aguelfi
Guest
When complications arise they are considered incidental and bundled into the procedure for the global period (0, 10 or 90 days). In situtations like this I don't bill for it, however if you ever do come across a situation where the pt was re-admitted for a different reason you would use modifier 24.
cpccoder2008
True Blue
Carrier's other than medicare
Is complications always included in the global or is this just a medicare thing ?? I don't bill it also because it was my understanding that any complications are included in global but i was told that some carriers will pay.
Is complications always included in the global or is this just a medicare thing ?? I don't bill it also because it was my understanding that any complications are included in global but i was told that some carriers will pay.
RebeccaWoodward*
True Blue
Often, it depends on what guidelines the carrier is following. In your scenario, it seems as if the carrier is following Medicare guidelines.
CPT-Not included:
Typical postoperative follow-up care.
CPT states that "typical postoperative follow-up care" includes only that care which is usually a part of the surgical service. Complications, exacerbations, recurrence, or the presence of other diseases or injuries requiring additional services should be separately reported
Medicare-Included:
All additional medical or surgical services required of the physician during the postoperative period of the surgery because of complications not requiring additional trips to the operating room
CPT-Not included:
Typical postoperative follow-up care.
CPT states that "typical postoperative follow-up care" includes only that care which is usually a part of the surgical service. Complications, exacerbations, recurrence, or the presence of other diseases or injuries requiring additional services should be separately reported
Medicare-Included:
All additional medical or surgical services required of the physician during the postoperative period of the surgery because of complications not requiring additional trips to the operating room