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Complication or Staged/Planned Procedure?

  1. #1
    Default Complication or Staged/Planned Procedure?
    Medical Coding Books
    If it's anticipated that a surgical incision will need to be debrided in the office during the post-op period because of the location of the incision and/or patient non-compliance, could this be considered a staged/planned procedure or would it just be considered a complication. My thought is it's more of a complication since it's not a procedure to fix the underlying problem but to help in the healing of the surgery itself, so these debridements would be included in the global period. Does anyone have any suggestions on how to code these cases?
    Thanks for any help!
    Sue Vermette, CPC, CPMA

  2. #2
    Milwaukee WI
    Default Staged/Planned procedure
    I would probably consider this a staged/planned procedure.

    Please note, the global period affects your E/M visits. Procedures are not generally subject to the global period, though you do have to use the appropriate modifier.

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

  3. #3
    Default Insurance Global rules
    Thanks for the response! I know that per CPT complications aren't included in the global. All of the carriers' rules I've seen though state that unless the patient is returned to the OR, care for those complications is not separately billable. They usually state something like this:
    The allowance for a surgical procedure includes the following services related to that surgery when performed by the same operating physician. • Any additional medical or surgical services by the surgeon during the postoperative period because of complications that do not require a return trip to the operating room. See below if a return trip to the operating room is required during the postoperative period
    This is why I'm torn about what to do with these debridements that could be considered complications by some auditors and staged/planned by others.
    Sue Vermette, CPC, CPMA

  4. Default
    for the additional debridements use the -58 modifier. these procedures were planned at the same time as the original procedure, therefore are staged procedures. even the office setting can be considered the "operating room". it doesn't necessarily have to be in a hospital or surgery center to be considered an operating room. When you the doc is performing any type of procedure, that is considered an "operating room".

    hope this helps.

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