We have a provider that performs excisions of neoplasms with or without lymph node dissections and biopsies. Sometimes with a hysterectomy and BSO. The problem comes when the patient presents for the first post op check-up, if the pathology report confirms malignancy, or the patient has complications directly related to the surgical diagnosis, the doctor wants to charge an established patient code instead of 99024. As I can’t find any supporting documentation that mandates that the first visit post operatively should be coded 99024, he is firm in his position.

I am aware that an unrelated diagnosis is allowed. Also, that Medicare deems any complication reported by the surgeon to be included in the global package. But where is it written, that when the reason for the visit is post operative exam, the status could be overridden if the patient has, for example hoarseness, following a Thyroidectomy?

Please advise me, so that I can share the information with my provider.