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Thread: Postop Infection

  1. #1

    Default Postop Infection

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    Just wondering if you can bill an E&M during a post op global. Pt was readmitted to hosp. due to infect. after sx.
    Doc saw pt in office and performed an E&M and put for DX code: Post OP infection; however pt. is still in global. Do I bill the E&M with a 24 modifier or is it post op? Thanks

  2. #2

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    Unless the patient is taken back to the OR, the E&M service would be global.

    ~L
    CPC, CGSC, COSC

  3. #3
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    I know Medicare does not pay post op infections, etc unless it is a return to surgery. However, I have seen other carriers pay for care for postop infections, pain, etc... usually because it is then above and beyond the "normal" postop followup.
    Donna, CPC, CPC-H

  4. #4
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    Just because other payers "pay for it" does not mean that it is right. If it is in the Global Period then why do it.
    Candice Fenildo, CPC, CPMA, CPB, CENTC, CPC-I
    AAPC Chapter Association Board of Directors ( Chair)
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    Candice.Fenildo@appcca.org

    "Nothing is stronger than the heart of a volunteer"

  5. #5
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    and visa/versa - just because Medicare ONLY pays if it's a return to the operating room - doesn't mean it shouldn't be covered.
    Donna, CPC, CPC-H

  6. #6
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    If you look in the CPT book under surgery guidelines, it states that "typical" postoperative follow-up care is included in the surgical package. A post-op infection is not "typical" postoperative care. I would bill it with a 24 modifier and the post-op infection diagnosis. With that said, Medicare rules clearly state that any follow-up visits related to the recovery of surgery is included in the surgical package and therefor can not be billed seperately. If this is a Medicare patient I would not bill it because it is included in the surgical package per Medicare guidelines. I hope this helps.

    Melissa Blow, CPC

  7. #7
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    I code/bill post op issues for other insurances because you can; if it's above and beyond the "norm" for post op follow up - to my knowledge, only Medicare requires it be a "return to operating room" for payment be considered for post op issures during global period"

    and yes, with a modifier .24 as mmelcam states
    Last edited by dmaec; 07-08-2008 at 08:02 AM.
    Donna, CPC, CPC-H

  8. #8
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    I agree with Donna and Melissa. Post op infection is above and beyond the norm and the E/M should be billed with the -24 modifier with the appropriate diagnosis for the infection.

  9. #9

    Default

    Our BC/BS carrier does not pay unless it's a return trip to the OR either.

    ~L
    CPC, CGSC, COSC

  10. #10

    Default

    I agree. I have found that many insurance carriers use Medicare guidelines for their decisions on whether or not something is payable. Just my 2 cents...

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