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ER--patient treated and returns for recheck

  1. Default ER--patient treated and returns for recheck
    Medical Coding Books
    Does anyone have any guidance on specific documentation of when or if a recheck can be charged when the patient presents to ER and then returns in a couple of days for a recheck, for example a wound or suture? A more specific example would be patient returns for wound recheck---dressing is changed---patient given pain meds--then basically "discharged" with instruction to follow up with physician or if needed before physician follow up to return to ER.

  2. #2

    Effective January 1, 2011, Medicare eliminated the 10 day global period for simple wound repairs (CPT 12001-12018). Follow-up visits and suture removal charges should be assigned as appropriate.

    FAQ 5. Can I bill for postoperative suture removals?
    Suture removals are typical post op care and are bundled with the initial procedure assuming the "same physician" performed the procedure. For coding and billing purposes, physicians of the same specialty in the same group practice are considered to be the "same physician." Suture removals for simple lacertation repair are not bundled into procedure codes 12001-12018 for Medicare.

    FAQ 6. Can I bill for follow up care and wound checks?
    The wording in CPT bundles "typical post operative care" into a procedure. Most likely, "typical" will have to be defined on a case-by-case or group by group basis. Wound checks two days after an "I and D" or repair of a contaminated laceration may or may not represent "typical care" and low level E/Ms may still apply. Packing removals may represent "typical care", as the packing removal is an inherent and expected component of the original Incision and Drainage. Once again the "same physician" concept applies. Wound checks following simple wound repairs (CPT12001-12018) are separately billable beginning the day after the procedure for Medicare.

  3. Default
    the key to this one is the pain meds given and the dressing was changed. You would bill an E/M level. you did not specify if this was MCARE or commercial. Someone else posted some good info regarding MCARE. Most of the time you will code an E/M level for commercial follow-ups. There are no established pt's with ED coding. MCARE is a little different and you have to look at those on a case by case basis. Also, your ED may have specific guidelines for follow-up visits that they want you to follow so check with them. I have coded for some ED's that would consider this and all follow-ups a N/C and I have coded for some that would bill for this case.

  4. #4
    Another good thing to remember are Global Days!! If a procedure has a 10 day global time, then you can't charge the patient for a check-up. But....if the patient comes in for their re-check and there is a separate, identifiable service provided in addition to the check up, then you can charge for that service. example: sutures have a 10 day global period, burn dressings have none. Some CPT books show these under the codes to let you know if they have any global days. There are 3 different time ammounts--10 days, 30 days and 90 days...and 30 days is only for priable care.

  5. #5
    As a facility, an E/M level may be charged (usually 1 or 2), as there is no global period for the facility.

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