Coding Q&A: Post-Op Issues
Disclaimer: Answers to incoming questions are provided by the members of the Society of Gynecologic Oncology (SGO) Coding and Reimbursement subcommittee and represent their opinion based upon the current and usual practices in the field. Every effort is made to ensure the accuracy of the information provided. However, the information neither replaces information in Medicare regulations, the CPT-4 code book, or the ICD-10 CM code book; nor does it constitute legal advice. Responses to questions are intended only as a guide and are not a substitute for specific accounting or legal opinions. SGO expressly disclaims all responsibility and liability arising from use of, or reliance upon this information as a reference source, and assumes no responsibility or liability for any claims that may result directly or indirectly from use of this information, including, but not limited to, claims of Medicare or insurance fraud.
Can you bill for inpatient and outpatient E/M services provided after surgery if the patient is seen for a post-operative complication such as a wound infection? Is a modifier required?
The CPT global surgical package includes all routine postoperative visits but payment rules vary depending on insurance carrier. The global package for Medicare includes the treatment of all complications managed outside the operating/procedure room. If a complication requires a return to the OR that can be reported with the appropriate surgical code, appending modifier 78 (unplanned procedure during the global period). For non-Medicare payers, you can report any additional E/M services above routine care for services related to the surgery, such as care for wound infections. If visits for conditions unrelated to surgery are provided in the global period, these can be reported by appending modifier 24. Modifier 24 is used for E/M services provided in the global period that are “unrelated” (e.g., a UTI or breast lump) or otherwise not part of routine postop care.
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