tci Part B Insider - 2004 Issue 14

Part B Coding Coach: 2 Questions To Ask Yourself When Reporting Postoperative Infections

If you're treating Medicare and private-payer claims the same, you could forfeit $80 or more per claim If you're including postsurgical infection care in the global surgical package of the primary procedure every time, you're missing out on legitimate revenue. To determine if you deserve additional reimbursement, ask yourself two questions:Question 1: Who's the Payer?  Medicare treats postoperative complications, including infections, differently than insurers who follow CPT guidelines. Although both CMS (Medicare) and CPT guidelines indicate that the global surgical package includes "typical" postsurgical care, the two sources differ on what qualifies as typical - which means you...

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