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global and complications? Help please!

  1. Default global and complications? Help please!
    Clearnace Sale
    I need help!! Can someone please tell me if there is an infection and it is a payor other than medicare.....patient is IN global can an office visit be billed or not?

    I've understood both ways....I see where medicare directs one way and then I see CPT directing another and payor guidelines also indicating another. What about medicaid and blue cross? CPT assistant specifically states to report a complication. I'm confused here

  2. Default
    Hi. The way I understand it, if the complication results in the patient returning to the OR, then you can bill for the subsequent surgery with modifier 78. The diagnosis for the second surgery would be your complication. The global period for the original surgery includes any E&M services regardless of complications. The only way you could bill for an E&M would be if the diagnosis was totally different (example: Patient had surgery for distal radius fracture. during the global period, the patient stubbed and fractured his toe. He happens to see the same provider who performed the original surgery. The provider could charge for the E&M service with modifier 24 and use the diagnosis for the fractured toe.)

  3. #3
    St. Louis, Missouri
    That is how I understood it to be also. You can only bill complications if the patient is taken back to the operating/procedure room.

    Melissa Blow, CPC

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