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Sort of a dumb question

  1. Default Sort of a dumb question
    Medical Coding Books
    I know I should know the answer to this and it seems so obvious, but I want to double check, in case Im wrong....

    My surgeon performed surgery on an established patient. At the completion of the surgery, he decided the patient needed to be admitted due to complications during the surgery. He wants to know if he can bill the admission code since the patient is technically in post-op.... I'm thinking he can, but I don't want to look like an idiot if I'm wrong.

    Can ANYONE answer this?


  2. #2
    North Carolina
    CPT guidelines and Medicare are similar but do have a slight variation.

    CPT's Surgical Package
    According to CPT, the surgical package includes the following

    -The surgical procedure;
    -Local infiltration, metacarpal/ metatarsal/digital block or topical anesthesia;
    -One related evaluation and management (E/M) encounter (including history and physical) that occurs after the decision for surgery has been made and is either on the date immediately prior to the procedure or on the actual date of the procedure;
    -Immediate postoperative care, including dictating operative notes and talking with the family and other physicians;
    -Writing orders;
    -Evaluating the patient in the postanesthesia recovery area;
    -Typical postoperative follow-up care.

    Medicare's View
    As is common, Medicare's rules differ slightly from that of CPT. Section 4821 of the Medicare Carriers Manual provides a definition of Medicare's global surgical package. Many other payers use this as a model. From a Medicare perspective, surgical procedures include the following services when furnished by the physician who performs the surgery:

    -Preoperative visits after the decision is made to operate beginning with the day before the day of surgery for major procedures and the day of surgery for minor procedures;
    -Intraoperative services that are a usual and necessary part of a surgical procedure;
    -All additional medical or surgical services required of the physician during the postoperative period of the surgery because of complications not requiring additional trips to the operating room;
    -Follow-up visits during the postoperative period of the surgery that are related to recovery from the surgery;
    -Postsurgical pain management;
    -Certain supplies;
    -Miscellaneous services (e.g., dressing changes; local incision care; removal of operative packs; 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).

    My opinion...the admission will be included in the post-op period.

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