Results 1 to 7 of 7

post op hematoma

  1. Question post op hematoma
    Exam Training Packages
    Help with post op situation:
    is within a post operative period (10 or 90), the doctor performs incision and drainage of hematoma 10140 or performs incision and drainage of abscess 10060 -- is this part of the surgical package? The way I read Medicare's guidelines it is. I have one doctor saying yes and another saying no. The one saying no, is saying it is above and beyond the normal post op care. But since he is doing these in the office, I am unclear on the appropriate modifier, if it can be billed. I thought I had it straight till my meetings with the doctors and my office manager.

    Any guidance would be greatly appreciated. Thanks in advance

  2. Default
    bringing post back to the top of list. Does anyone have any opinions on this? Thanks for any help.


  3. #3
    Default
    It's included per CMS's guidelines... but not included per CPT guidelines... so both your docs are right in a way... it depends on what kind of insurance the patient has.

    For Medicare and any payor who follows CMS guidelines, treatment of post-op complications are included unless the patient is returned to the operating room.

    It's a good idea to have the Guidelines handy so you can defend yourself.. you know what you are talking about!

    Also, it's a good idea to check all of your payors' surgical package guidelines. Most of them are published on their website.... and most ARE following CMS guidelines.

    Erica

  4. #4
    Location
    St. Louis, Missouri
    Posts
    262
    Default
    I agree with Erica.

    Melissa Blow, CPC

  5. Default
    I showed them this part of the CMS article, and tried explaining it is global, but the doctor still disagreed. The doctor performs office procedures in the office, removal of lesions etc that do not warrant the hospital OR, so he is telling me it is ok, he is doing it in an operating room, to use modifier 78. (The changes in the wording of modifier 78 this year, leans the doctor to this modifier.

    A. Components of a Global Surgical Package
    "Complications Following Surgery - All additional medical or surgical services
    required of the surgeon during the postoperative period of the surgery because of complications which do not require additional trips to the operating room;"


    But then there is this following statement, in the manual, and according to the doctor and his wife, the hematoma is not part of normal recovery from surgery. I somewhat agree, but to me when there are abdominplasty, or surgeries of that extent etc done, a hematoma (maybe not part of normal recovery) could be expected to happen, and I do not see the medical necessity in billing for it. Plus, then I would have to use modifier ?, modifier 79would not be correct, it is not unrelated (without the procedure being done the patient would not have had the hematoma); could you use modifier 58, I know it is not stage, but in the reading of the description it states "or related procedure"

    B. Services Not Included in the Global Surgical Package
    "Treatment for the underlying condition or an added course of treatment which is not part of normal recovery from surgery;"


    the quotes are from Chapter 12 of CMS Medicare claims processing Manual.

    confused, I had this straight, but know with the doctors view, I am needing other coders opinions. and opinions how to address this to the doctor and his wife. The insurance person before me was adding modifier 24 to the px The doctors wife's opinion is if we have to go back to the hospital OR we will. again I am scared the doctor would be faced with medical necessity.

    Sorry for such a long reply, I think I may be putting too much into this.

    codegirl0422, CPC, CBCS





    Quote Originally Posted by Erica1217 View Post
    It's included per CMS's guidelines... but not included per CPT guidelines... so both your docs are right in a way... it depends on what kind of insurance the patient has.

    For Medicare and any payor who follows CMS guidelines, treatment of post-op complications are included unless the patient is returned to the operating room.

    It's a good idea to have the Guidelines handy so you can defend yourself.. you know what you are talking about!

    Also, it's a good idea to check all of your payors' surgical package guidelines. Most of them are published on their website.... and most ARE following CMS guidelines.

    Erica
    Last edited by codegirl0422; 04-30-2008 at 10:09 PM.

  6. #6
    Default
    No YOU are not, your doc and his wife are. She actually is going to convince her husband to bring patient's back to the OR just get additional reimbursement they do not deserve? That is ridiculous and abusive behavior. I feel for you.

    If they are doing it in the office and it does not require a return trip to the OR, then it's part of CMS's global surgical package.

    Modfier -79 and -58 are not correct. See these links -
    http://www.medicarenhic.com/provider...rymod_1207.pdf

    http://www.medicarenhic.com/provider...rgeryguide.pdf


    "Treatment for the underlying condition or an added course of treatment which is not part of normal recovery from surgery;" does NOT include minor complications of surgery.. those are clearly included per CMS guidelines.


    If they insist on adding modifier -24 for E&Ms or -79 for procedures, they are putting themselves at risk. This is fraud. Both modifiers would be telling Medicare that the services are unrelated to the surgery and that is ..well.. it's a big fat lie.

    Good luck!!!!
    Erica

  7. Default
    Thanks Erica, that is the way I feel but I can't convience them differently. I sorta understand where they are coming from but it doesn't work that way. I appreciate you taking the time to respond again. I know I knew it the right way but then after a meeting or two with them, I started to doubt myself.

Similar Threads

  1. Post-Operative Hematoma
    By lindaconway in forum Medical Coding General Discussion
    Replies: 0
    Last Post: 03-05-2013, 01:45 PM
  2. Coding for evacuation of a hematoma Post Umbilical hernia repair
    By SCHAUFLER in forum Medical Coding General Discussion
    Replies: 0
    Last Post: 02-08-2013, 04:32 PM
  3. post op hematoma linked to anticoagulants
    By jtuominen in forum Diagnosis Coding
    Replies: 0
    Last Post: 01-02-2013, 02:31 PM
  4. Post-op Hematoma
    By asasands in forum E/M
    Replies: 1
    Last Post: 05-22-2012, 06:31 PM
  5. Lap drainage of hematoma post-appendectomy
    By Leanne in forum General Surgery
    Replies: 2
    Last Post: 07-11-2008, 11:25 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?

Login

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.