AAPC - Back to school
Results 1 to 2 of 2

Thread: Sort of a dumb question

  1. #1

    Default Sort of a dumb question

    AAPC: Back to School
    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
    Join Date
    Apr 2007
    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.

Similar Threads

  1. This may be a dumb question...but?
    By bpowell121774 in forum General Surgery
    Replies: 2
    Last Post: 10-28-2013, 11:55 AM
  2. Dumb Question?
    By bpowell121774 in forum General Surgery
    Replies: 2
    Last Post: 03-08-2013, 04:31 AM
  3. dumb question
    By BABS37 in forum Pathology & Clinical Laboratory
    Replies: 0
    Last Post: 03-01-2012, 02:31 PM
  4. dumb question?
    By PLAIDMAN in forum Orthopaedics
    Replies: 1
    Last Post: 01-26-2012, 12:39 PM
  5. dumb question...
    By kibbit99 in forum Orthopaedics
    Replies: 3
    Last Post: 09-11-2009, 10:42 AM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts

Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?


Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.