Payer Preferences: You Could Be Missing Out On Legitimate Post-Op Revenue

Why This Topic Matters

Postoperative complication claims can be paid or denied differently depending on the payer’s rules, contract language, and global-period policies. Understanding the broad guidance in this article can help reduce missed revenue and avoid billing errors for post-surgical infection care.

Article Sections

1. Tip 1: Distinguish Between Medicare and Non-Medicare Patients

   This section compares how different payers approach postoperative complication services during the global period. It discusses the broad differences between CMS-based handling and CPT-based handling for non-Medicare claims.

2. Tip 2: Decide What Modifier to Use

   This section covers the general use of modifiers in postoperative complication claims. It focuses on how modifier selection can vary by payer and service setting.

3. 3 Examples Show You What to Do

   This section presents example scenarios involving postoperative infection care in different settings. It is intended to show how the broader billing concepts apply in practice.

4. Don’t Expect Total Reimbursement With 78

   This section explains the general reimbursement implications associated with claims submitted during the postoperative period using a specific modifier. It also notes the effect on the global period.