Postop Infection

Hopp

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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

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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

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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

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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

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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 :)
 
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mbort

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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

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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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