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Another global period question

  1. #1
    Default Another global period question
    Medical Coding Books
    If a patient was seen on a friday for a laeration and the laceration was repaired. Monday he comes back and now it is infected. He is given meds. I think that would be included in the global for the repair but how woudl I code the visit? What ICD? It isnt attention to stutures? Would I code infected wound?

    What about the E/M 99212-55?

  2. #2
    Default
    The return visit on Monday is included. No separately billable charges.

    Friday's billing should be your E/M (if appropriately documented) modifier 25 and the laceration repair.

    Monday's visit should be 99024 with the postop wound infection and/or attention to sutures for the ICD9... whatever the documentation supports.

  3. #3
    Location
    Columbia, MO
    Posts
    12,531
    Default
    I agree

    Debra A. Mitchell, MSPH, CPC-H

  4. #4
    Location
    Locust Grove, GA
    Posts
    11
    Default
    Modifier 55 - Postoperative Management Only: When one physician performed the postoperative management and another physician performed the surgical procedure, the postoperative component may be identified by adding modifier 55 to the usual procedure number. ... for minor surgery the "Global Period" would be 10 days. It appears that the patient saw the same physician so modifier 55 "would not" be necessary...I agree w/ -AR- .. if the visit on Monday was in relation to the the laceration repair the code would be "99024...

    Chronicles Billing Inc.

  5. #5
    Default
    thanks everyone.

  6. #6
    Location
    Capital Coders, Columbia, SC
    Posts
    145
    Default Modifier 55?
    I'm not sure how modifier 55 came into the picture with this scenario. This would not apply to this type of situation in which the patient undergoes a procedure and returns to the same practice, or even the same group, for followup. The patient is in a global period status under the group's tax ID number, or group NPI. In order for a physician to report modifier 55 post-operative care only, the physician who performed the procedure must report the procedure with modifier 54, surgical care only, and must be from a different group, or under a different tax ID #. This is usually pre-arranged and a written agreement involved.

  7. #7
    Default Interesting
    Alot of input on this, but I would pull out a level two on this with modifier 24 and DX of wound infection.


    Reason being, well if it's Medicare than leave it as include in the global period. But if it's a PPO patient, that means more than likely you go off the rules of the AMA in regards to coding.

    And the descripiton of the AMA

    CPT's 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.


    Look her at typical, so if the physician states that this case is out of the typical box, than I would say you can code an low level E/M in this case.

    Talk with your physician.

    Reason I say this is, in my pratice it's routine for check ups and just straight suture removal. I rarely see the patients come back and have an infection than require meds. So thats outside the typical postoperative care for me.


    I work to bring my physician money in the most legal way. So thats my input.

    Respectfully
    Daniel,CPC

    P.S- Remember sometimes the difference in your descision making has to do with the insurance.

  8. #8
    Location
    Jacksonville, Florida - 90417
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    187
    Default
    Quote Originally Posted by klp010102 View Post
    If a patient was seen on a friday for a laeration and the laceration was repaired. Monday he comes back and now it is infected. He is given meds. I think that would be included in the global for the repair but how woudl I code the visit? What ICD? It isnt attention to stutures? Would I code infected wound?

    What about the E/M 99212-55?
    By laceration repair, I imagine you are referring to wound repairs (skin). These have a 10-day follow-up period. If the patient has Medicare, an infection related to the procedure would be included in the global surgical package and an E/M would not be separately reportable.

    If the patient has insurance that follows CPT's definition of the global surgical package, E/M visits to treat complications arising from the procedure are not considered routine post-op care and can be reported separately.
    Maryann

    Maryann C. Palmeter, CPC, CENTC, CPCO

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