Wiki Post Op Wound

[lilyirecta@gmail.com]

If the patient's incision develops a wound postoperatively (90-day global) and comes into the office weekly for wound care, can we bill for the debridement? Or is this considered part of the global package? Even though it's a complication and requires the patient to come in more frequently than initially planned?

 

[podcoder70]

Unfortunately the provider usually gets dinged for the unreliable patient. If the patient has to be brought back to surgery the 78 modifier can be used. The 79 modifier indicates the condition is unrelated to the procedure for which the 90 day global applies, so that does not work either. Neither can an e&m be coded because the 24 modifier indicates that the service is unrelated the to procedure with the global period. The 58 modifier, however, may be appropriate in this case as the condition is "related" to the surgery. Documentation should be solid to support the definition, which states, in part: Staged or Related Procedure or Service by the Same Physician During the Postoperative Period: It may be necessary to indicate that the performance of a procedure or service during the postoperative period was (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. This circumstance may be reported by adding modifier 58 to the staged or related procedure.
This is tricky, though, and may be difficult to support. Be sure the documentation clearly defines the depth of debridement of the wound as well as what type of tissue was debrided and the medical necessity. Mild dehiscence or scab on the wound does not warrant the extra payment.

 

[Heatherc7]

Hi Lily,

I was advised by AAPC, modifier -58 can be used for therapeutic debridement. There are some wound care services, that typically take several therapeutic debridements to promote healing. If there is advanced knowledge that additional debridements will need to be performed, just make sure that the provider documents it.

Hope that was helpful!