Wiki post op complications

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MarineMom1

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Hi Everyone,
I need some help. We have a pt that had surgery (was suppose to be out pt surgery) but the pt ended up with post op complications and she ended up staying a total of 7 days. Another doctor also helped with the post op problem the pt had. My questions is may we charge for these extra days? The surgery has a 90 day global period:confused:. If so, which modifier would I use.

Thanks,
Marine Mom:)
 
Hi,

In CPT (2010 Professional) on page 52, the description for follow up care for therapeutic surgical procedures indicates complications should be reported separately. However, in the Medicare Global Surgical Package, it states complications are included in the global surgical package and cannot be reported separately (see http://www.cms.hhs.gov/manuals/downloads/clm104c12.pdf, section 40):

From the manual: "Complications Following Surgery - All additional medical or surgical services required of the surgeon during the postoperative period of the surgery because of complications which do not require additional trips to the operating room"


What this means is, reporting of complications for surgical cases will likely depend upon the individual payer rules.

Jen
 
Just would like to confirm the answer to this. A pt is admitted into the hospital and has surgery, the surgeon ask the pain/management doctor to visit the pt and write up his RX for his meds. How would that doctor bill for going in and just writing up his RX?

Thanks Lisa
 
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complications

for major surgeries, routine post operative care is included for 90 days following the surgery. For minor surgery, routine post-operative care is included in the surgical package for 10 days and some other surgeries do not have a post operative period, However, if the post operative care requires a trip to the operating room, use modifier 78 to show the return to OR and most carriers (including Medicare) will pay!
JM
 
In the case where a surgeon performs surgery and another physician (outside the surgical specialty) sees the patient, that physician may bill his/her services. So in the example where the surgeon asks a pain management physician to come in and evaluate the patient and provide a prescription, the pain management physician may report the services performed. It will depend on what was actually done. Was it a consult (non-Medicare)? Is the pain management physician coming in to manage the patient's pain (E/M service)? Much will depend upon the documentation in this case.

Reporting complications during the global surgical period affects the surgeon (and others in the same surgical specialty in a group practice) because payment for follow up care is included in the payment for the surgery. Other physicians may report services provided to the patient.

Jen
 
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