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Postop Infection

Hopp

Guru
Messages
228
Best answers
0
Just wondering if you can bill an E&M during a post op global. Pt was readmitted to hosp. due to infect. after sx.
Doc saw pt in office and performed an E&M and put for DX code: Post OP infection; however pt. is still in global. Do I bill the E&M with a 24 modifier or is it post op? Thanks
 

dmaec

True Blue
Messages
1,133
Location
Hibbing, Minnesota
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0
I know Medicare does not pay post op infections, etc unless it is a return to surgery. However, I have seen other carriers pay for care for postop infections, pain, etc... usually because it is then above and beyond the "normal" postop followup.
 

dmaec

True Blue
Messages
1,133
Location
Hibbing, Minnesota
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0
and visa/versa - just because Medicare ONLY pays if it's a return to the operating room - doesn't mean it shouldn't be covered. ;)
 

mmelcam

Expert
Messages
262
Location
St. Louis, Missouri
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0
If you look in the CPT book under surgery guidelines, it states that "typical" postoperative follow-up care is included in the surgical package. A post-op infection is not "typical" postoperative care. I would bill it with a 24 modifier and the post-op infection diagnosis. With that said, Medicare rules clearly state that any follow-up visits related to the recovery of surgery is included in the surgical package and therefor can not be billed seperately. If this is a Medicare patient I would not bill it because it is included in the surgical package per Medicare guidelines. I hope this helps.
 

dmaec

True Blue
Messages
1,133
Location
Hibbing, Minnesota
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0
I code/bill post op issues for other insurances because you can; if it's above and beyond the "norm" for post op follow up - to my knowledge, only Medicare requires it be a "return to operating room" for payment be considered for post op issures during global period"

and yes, with a modifier .24 as mmelcam states :)
 
Last edited:

mbort

True Blue
Messages
2,338
Location
ENGLEWOOD/DENVER
Best answers
0
I agree with Donna and Melissa. Post op infection is above and beyond the norm and the E/M should be billed with the -24 modifier with the appropriate diagnosis for the infection.
 

beck627

Networker
Messages
37
Best answers
0
I agree. I have found that many insurance carriers use Medicare guidelines for their decisions on whether or not something is payable. Just my 2 cents...:D
 
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