tci ED Coding & Reimbursement Alert - 2004 Issue 8

Reader Question: Determine Payer for Follow-Up Charge

Question: The ED physician performed an incision and drainage procedure on a patient two days ago. Today the patient returned for a packing removal, and due to some concerning redness around the wound, the physician ordered an intramuscular antibiotic injection. Should we charge for a follow-up visit? Washington, D.C., SubscriberAnswer: The correct answer to your question depends on whether the patient's insurer is Medicare or is following Medicare's payment guidelines. Medicare instructs that "postoperative complications" treated within the global period are only payable if a return to the operating room is required -- so for a Medicare patient...

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