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Help with procedure during global

  1. Default
    Medical Coding Books
    Quote Originally Posted by arme2783 View Post
    Yeah, its a real problem that there is no clear definition of surgical procedures in CPT, and a lot of payors use this to reduce the payment based on multiple surgery rule. Imagine having a 50% reduction on a cast application code just because it is in a surgery section of CPT, I dont think anyone consideres cast application as surgery

    Uniform Discharge Data Set defines surgery as: incision, excision, amputation, introduction, endoscopy, repair, destruction, suture and manipulation. However, neither this nor any other definition of surgery has been used to place codes in any particular section of the CPT code set. Its just created to be convenient to find the codes
    One more question regarding post operative infection complications. If patient presented with an infection at the surgical site and the physician did not perform surgery but did send patient home with a prescription for antibiotics can an E/M still be billed as a complication during the global surgery with modifier 24

  2. #12
    Location
    North Carolina
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    3,126
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    Just FYI-

    Medicare includes complications as part of the surgical package. Unless it's an unrelated problem, the E/M is not billable.

    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;"

    Page 91

    http://www.cms.gov/manuals/downloads/clm104c12.pdf

  3. #13
    Location
    Long Island/New York
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    1,271
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    Quote Originally Posted by RebeccaWoodward* View Post
    Just FYI-

    Medicare includes complications as part of the surgical package. Unless it's an unrelated problem, the E/M is not billable.

    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;"

    Page 91

    http://www.cms.gov/manuals/downloads/clm104c12.pdf
    I agree....

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