post op care of sx by another physician

heathermc

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We have a medicare patient that had surgery out of state for mass of the abdomen/hernia repair (codes 49566/49568/15734/51860) by a physician in Missouri. Patient returned home and we continued post op care, and eventually the patient had to be admitted to the hospital during the global period (within a month) for abdominal wall cellulitis/drainage, which is a complication of the origianl surgery. We have been reimbursed for the post op care, but cannot get reimbursed for the hospital care (pt was in hospital for several days). Are there any suggestions on what modifiers to use so that we can be reimbursed for our services, or do we have to consider this part of the global period and not be compensated? Any suggestions would be appreciated. Thanks in advance.
 

ARCPC9491

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Well the global period from the hernia repair wouldn't apply to you from the other surgeon

For the normal post op care you should have appended modifier 55 and gotten paid.

Your global would have started with the complication or drainage of abscess... Did you get paid for the drainage? You should've. If they were in the hospital subsequent to the procedure your doc did it would be global. You could try to appeal, maybe try modifier 24 if it were a different issue unrelated to the drainage performed by your doc

I hope that wasn't as confusing as I think I made it, LOL
 
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