Author Topic: Return to ASC for bleeding on 1st post op visit  (Read 94 times)

EDREIBELBIS

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Return to ASC for bleeding on 1st post op visit
« on: July 09, 2018, 02:35:57 PM »
Hello,

I am at a loss on the best way to handle the billing for this visit; if we CAN bill anything for the visit outside of the post-op. Patient had excision of bone in left foot on June 29th. On July 2 patient came in to the office for his first post-op and it was noted that he had uncontrolled bleeding, he had to be taken into our adjoining ASC to open the surgical site control the bleeding and re-close. The opt note in regards to the visit is below. Additionally, I don't know if it would matter, but original procedure was NOT preformed in our ASC, but at local medical center as outpatient surgery.

Would we be able to bill for this secondary closure with a 78 mod? My provider wants to at least bill for a facility fee, but I'm not sure what we can do in this case. Primary payer is Medicare.

"1st post ľop

On exam, it was obvious that there was a hematoma at the surgical site. On suture was removed and the area compressed. Approximately, 10cc of congealed hematoma was expressed. At this point, a stready steam of bleeding was noted. The area was compressed for about 20 minutes, but this failed to stop the bleeding.

The patient was then brought into the operating suite in our office. A sterile prep and drape were performed after a local nerve block. An above-ankle pneumatic tourniquet was applied and inflated to 250 mmHg. All remaining sutures were removed. The bleeding vessel was identified and clamped with a hemostat and ligated using 3-0 vicryl suture. The tourniquet was released and no further bleeding was noted. The skin was closed with 4-0 nylon. A dry,s terile dressing was applied."

Thank you in advance!
Emily

kristin

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Re: Return to ASC for bleeding on 1st post op visit
« Reply #1 on: July 09, 2018, 03:09:25 PM »
In my opinion, there is nothing you can bill for here. The bleeding/hematoma is directly related to the surgery, and as a result is considered a post-op complication, which is part of the 90 day global period.