2 Questions to Ask Yourself When Reporting Postoperative Infections

Why This Topic Matters

Postoperative infection care can affect reimbursement and claim accuracy during the global surgical period. Understanding when payer policies differ helps avoid missed payment opportunities and improper reporting.

Article Sections

1. Question 1: Who's the Payer?

   Explains that postoperative complication handling may vary depending on whether the claim follows Medicare-oriented guidance or CPT-based private-payer guidance. The section focuses on the importance of payer-specific treatment of postsurgical care during the global period.

2. Question 2: Which Modifier Do I Need?

   Introduces modifier-related considerations for reporting treatment of postoperative infections under different payer policies. The section discusses how the claim should reflect the type of service and the context of care.

3. 3 Examples Show You What to Do

   Presents several billing scenarios involving postoperative infection management in office, hospital, and operative settings. The examples are used to illustrate how payer type and care setting affect reporting decisions.

4. Don't Forget the Diagnosis:

   Notes the need to associate an appropriate diagnosis with reported services related to postoperative infection care. This section addresses diagnosis reporting in the context of postoperative complication claims.

5. Don't Expect Total Reimbursement With -78

   Describes reimbursement considerations tied to a specific modifier during the postoperative period. The section explains that payment may differ from full fee schedule reimbursement when this modifier is used.