Wiki Postop Infection

[Hopp]

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

 

[Treetoad]

Unless the patient is taken back to the OR, the E&M service would be global.

 

[dmaec]

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.

 

[Candice_Fenildo]

Just because other payers "pay for it" does not mean that it is right. If it is in the Global Period then why do it.

 

[dmaec]

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]

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]

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

 

[mbort]

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.

 

[Treetoad]

Our BC/BS carrier does not pay unless it's a return trip to the OR either.

 

[beck627]

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...