Reimbursement Advisor

Reporting prolonged patient care for postop complications


Q A patient who underwent a total abdominal hysterectomy and bilateral salpingo-oophorectomy (TAH/BSO) had multiple severe postoperative complications (hypotension, acute renal failure with anuria, hypokalemia, and a broken humerus due to a fall sustained while trying to get out of bed). As a result, the physician spent 2 to 4 hours per day with the woman, but she was not transferred to the intensive care or critical care units (ICU/CCU). How can we get reimbursed for the extra time spent with the patient?

A First, it is important to know if the surgeon who operated and the physician who provided postoperative care for the complications are one and the same. If so, and if the problems were related to the TAH/BSO, the payer (e.g., Medicare) may include the postoperative care in the global fee, even if the physician spent more time with the patient each day than is typical. If the documentation clearly shows care of these problems were not related to the TAH/BSO, bill the inpatient hospital E/M services code and add the modifier -24.

You also can use the prolonged-services codes (99356 to 99357) for face-to-face contact—as well as the subsequent hospital care service—if the time was carefully documented.

Also consider the Critical Care services codes (99291 to 99292), as there is no requirement that the patient be admitted to the ICU or CCU to report them. However, the patient would have to meet the CPT definition of critically ill or injured.

This article was written by Melanie Witt, RN, CPC, MA, former program manager in the Department of Coding and Nomenclature at ACOG. She is now an independent coding and documentation consultant. Her comments reflect the most commonly accepted interpretations of CPT-4 and ICD-9CM coding. When in doubt on a coding or billing matter, check with your individual payer.

Next Article: