Medicare Compliance & Reimbursement - 2018 Issue 4
You Be the Coder: Include Non-OR Complication Treatment in Global Surgery Payment
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Article Overview
This coding article discusses Medicare global surgery guidance for postoperative complication-related care, with emphasis on whether treatment occurs outside an operating room and how that affects billing in the global period. It is intended for coders and billing staff working with surgical follow-up encounters, particularly office-based and hospital outpatient settings, and it references Medicare guidance on global surgery concepts and related outpatient visit reporting.
Why This Topic Matters
Understanding what is included in a surgical global period helps prevent unbundling and supports accurate reporting of follow-up encounters after surgery. The article is relevant to practices that manage postoperative infections or other complication-related visits and need to distinguish between bundled care and separately reportable outpatient services.
Article Sections
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Question
Introduces a postoperative follow-up scenario involving an incision issue after a knee procedure and asks whether the encounter can be billed separately.
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Answer
Summarizes Medicare global surgery guidance for complication-related postoperative care and explains the general billing treatment of follow-up services during the global period.
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OR definition and billing note
Provides Medicare’s definition of an operating room for global surgery purposes and notes a related outpatient clinic billing consideration.
What You Will Learn
- How Medicare global surgery guidance treats postoperative complication-related services
- How the presence or absence of an operating room visit affects postoperative billing
- How follow-up encounters in an outpatient clinic setting may be reported at a high level
- How global period concepts apply to surgical follow-up care after a major joint procedure
Who Should Read This
- Medical coders
- Billing specialists
- Revenue cycle staff
- Orthopedic practice staff
- Compliance personnel
Codes Discussed
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