tci ED Coding & Reimbursement Alert - 2004 Issue 1

Reader Question: Medicare Won't Pay for Adverse Reactions

Question: A patient presented in the ED with a laceration on her leg, which the physician sutured. Four days later, the patient returned because the wound area was red and inflamed and was draining pus. Should we charge the patient for this visit, or is it included in the wound repair procedure code? Indiana Subscriber Answer: Ultimately, the answer to this question depends on whether the patient has Medicare. Medicare usually bundles postoperative visits into the global surgical package when they represent complications from the original surgical procedure - in this case, infection of the wound - unless the...

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