Complications can occur at any time in the care and treatment of an orthopedic condition or injury. For instance, with routine Orthopedic surgeries like total hip (THR) and knee (TKR) replacements, patients often encounter complications while still under the global care period for the surgery. These can be the result of additional injury or accident, infection or an unforeseen problem with the prosthetic device. And these complications can run the gamut from problems clearly related to the original procedure to other injuries or procedures that seem to have nothing to do with the original surgery or operative site. Orthopedic coders must know the difference between what Medicare and commercial payers consider a postoperative complication to be properly reimbursed for their services.
A major surgery has a 90-day global period. For example, if a patient undergoes a total hip replacement (27130, Arthroplasty, acetabular and proximal femoral prosthetic replacement [total hip replacement], with or without autograft or allograft), this procedure has a 90-day global period that includes preoperative visits after the decision to operate, intraoperative services, routine follow-up care, postoperative visits, pain management, supplies and miscellaneous services (e.g., removal of casts and splints).
For example, the patient with the total hip replacement (THR), in the course of her recovery from the THR, falls and breaks her wrist and returns to the same orthopedic surgeon to have her wrist set. Because the new procedure is unrelated to the hip surgery, the operating surgeon (OS) can bill for the wrist fracture using the appropriate code (e.g., 25606, Percutaneous skeletal fixation of distal radial fracture or epiphyseal separation), but must add modifier 79 (Unrelated procedure or service by the same physician during the postoperative period).
The above example is a fairly straightforward example of non-routine follow up care within a global surgical period. But at the heart of the confusion over postoperative complications is whether the complication is related to the original surgery (and by whose definition of related) and whether postoperative complications are in fact covered by the global surgical period. Many coders have been working for years under the impression that any complications related to surgery are always billable separately from the surgery, as long as they use the appropriate modifier. Part of the confusion over postoperative complications lies in the difference between Medicare’s rules and commercial insurer’s rules. That’s why you have to be extra vigilant when it comes to your documentation.
Join this webinar, presented by expert Lynn Anderanin, CPC, CPC-I, COSC. You’ll learn what documentation is necessary for complication cases to be coded correctly and processed using specific case studies to assign the appropriate CPT® codes, modifiers, and diagnoses.
Go an extra step by confronting ICD-10-CM. Make sure your documentation measures up, so that you can apply that ultra specific complication code and help your claim success.
This session will help you:
Who should attend? Orthopedic surgeons, non physician providers, coders, collections staff, surgery schedulers, practice managers/administrators
Lynn Anderanin, CPC, CPMA, CPPM, CPC-I, COSC, is the Sr. Director of Coding Education for Healthcare Information Services, a physicians revenue cycle management company. She has over 35 years experience in all areas of the physician practice, and specializes in Orthopaedics. Lynn is currently a workshop and audio presenter. She is a former member of the American Academy of Professional Coders (AAPC) National Advisory Board, and has served...
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