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billing postoperative complications

postoperative complications

A. Billed as a new procedure separate from the original surgery.

B. Identified on the CMS-1500 claim with a 5-digit modifier.

C. Included as part of the global surgery but are billed separately.

D. not submitted to the third-party payer for reimbursement.

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Global surgery payment involves reimbursement for services rendered during the pre-(before the surgery),intra-(during the surgery), and post-op care(after the surgery). The preoperative visit does not include the "decision for surgery"; the post op includes any services rendered related to the surgery including regular post-care and complications related to surgery during the established period (Center for Medicare and Medicaid Services [CMS], 2011, Feb. 2). For minor surgery, the post-op ...

Solution Summary

The solution involves a discussion of billing procedures during postoperative complications. It explains when you can bill separately and when it is part of the global surgical billing.