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Thread: post of complication question?

  1. #1
    Join Date
    Apr 2007

    Post post of complication question?

    AAPC: Back to School
    A patient was admited to the hospital for complications from her surgery that she had 15 days earlier. 99253/24 was billed and the insurance denied it as inclusive. Was wondering if anyone had any modifier suggestions,or if this was even billable, or is included in the post op global period?

  2. #2


    When complications arise they are considered incidental and bundled into the procedure for the global period (0, 10 or 90 days). In situtations like this I don't bill for it, however if you ever do come across a situation where the pt was re-admitted for a different reason you would use modifier 24.
    adrianne, cpc

  3. #3
    Join Date
    Apr 2007

    Default Carrier's other than medicare

    Is complications always included in the global or is this just a medicare thing ?? I don't bill it also because it was my understanding that any complications are included in global but i was told that some carriers will pay.

  4. #4
    Join Date
    Apr 2007
    North Carolina


    Often, it depends on what guidelines the carrier is following. In your scenario, it seems as if the carrier is following Medicare guidelines.

    CPT-Not included:

    Typical postoperative follow-up care.

    CPT states that "typical postoperative follow-up care" includes only that care which is usually a part of the surgical service. Complications, exacerbations, recurrence, or the presence of other diseases or injuries requiring additional services should be separately reported


    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

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