Addressing Noncovered Services With Your Patients

Betsy Nicoletti, MS

Disclosures

March 25, 2019

In This Article

Optimal Coding for a Surgical Procedure

Billing for Follow-up After a Surgical Procedure

Question: I am a general surgeon, and I performed an open, partial colectomy on a patient. The next week, he returned to the office for a dressing change. Can I bill for that return service, and if so, with what codes?

Answer: You cannot bill for this dressing change. Surgical services are paid with a single payment that, according to Medicare, "includes all the necessary services normally furnished by a surgeon before, during, and after a procedure."[2] Surgical services are assigned a global period of 0 or 10 days (minor procedures) or 90 days (major procedures).

Colectomy is considered a major surgical procedure. Both Current Procedural Terminology (CPT) and Medicare define what is included in the global payment for a major procedure. CPT says "typical" post-op follow-up is included. CMS has a broader definition and includes "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."

Changing the patient's dressing at a post-op visit is not separately billable.

Treating an unrelated problem during the post-op period is permitted. If your colectomy patient presented for evaluation of a lipoma or breast lump a month after surgery, you could bill the evaluation and management service with modifier 24. This will require a new diagnosis, alerting the payer that the evaluation was not related to the surgery.

Have a coding question? Send it in and it may be answered in a future column. (Please be sure to note your specialty in the text of the question.)

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