Post partum open wound

carol52

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Hello, I have a patient had cesarean section 9 days post op .
Incision had re opened and came to ER .
On exam 1 cm opening to the right of the midline iodoform was removed .
incision cleaned with peroxide and re-packed with iodoform and pressure dressing.
Is this considered part of the global and cannot be billed. not what cpt code would be appropriate.
Thanks,
Carol
 

csperoni

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Unless the wound required return to the OR, this is included in global per CMS guidelines.
From the Medicare global surgery booklet https://www.cms.gov/outreach-and-ed...oducts/downloads/globallsurgery-icn907166.pdf page 6 excerpt below:

What services are included in the global surgery payment?
Medicare includes the following services in the global surgery payment when provided in addition to the surgery:
• Pre-operative visits after the decision is made to operate. For major procedures, this includes pre-operative visits the day before the day of surgery. For minor procedures, this includes pre-operative visits the day of surgery.
• Intra-operative services that are normally a usual and necessary part of a surgical procedure
• All additional medical or surgical services required of the surgeon during the post-operative period of the surgery because of complications, which do not require additional trips to the operating room
• Follow-up visits during the post-operative period of the surgery that are related to recovery from the surgery• Post-surgical pain management by the surgeon
• Supplies, except for those identified as exclusions
• Miscellaneous services, such as dressing changes, local incision care, removal of operative pack, removal of cutaneous sutures and staples, lines, wires, tubes, drains, casts, and splints; insertion, irrigation, and removal of urinary catheters, routine peripheral intravenous lines, nasogastric and rectal tubes; and changes and removal of tracheostomy tubes

Please note: CPT rules about billing complications may vary. All of our payors follow the CMS global surgery guidelines.
 

thomas7331

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Yes, agree, but would just note that in the situation you describe the global period only applies to the provider who performed the cesarean section (or other providers of that specialty in the practice). If the treatment of the wound in the ER that you're describing here was done by an ER physician, this is not part of the global period since that is a different specialty and it would be a separately reportable service.
 

csperoni

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Yes, agree, but would just note that in the situation you describe the global period only applies to the provider who performed the cesarean section (or other providers of that specialty in the practice). If the treatment of the wound in the ER that you're describing here was done by an ER physician, this is not part of the global period since that is a different specialty and it would be a separately reportable service.
Thank you for clarifying Thomas. I was interpreting (perhaps incorrectly) that it was the same obgyn physician/physician group. Yes, definitely if it is a different physician group or specialty, then billable service and not part of global.
If it is a separate specialty/physician group, the limited information provided does not seem to justify wound care codes (no debridement, no notation of devitalized tissue, etc). I would suggest ER visit codes 99281-99285.
 
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