Reimbursement for same day return to OR cases

[tweekin19]

How does the reimbursement work for return to OR cases secondary to a surgical complication (same day/within 24 hours)? I tried to search this on the medical coding forum but couldn't get a clear answer in regards to our specialty. I think for surgeons, if it's due to a complication due to surgery it's a reduced rate (70-90% of total) based on this site https://www.aapc.com/blog/24234-choose-which-modifier-58-78-or-79/

Does it matter with regards to anesthesia(same vs different anesthesiologist)? The modifier 78 only pertained to "same physician." A senior in my group said it would only reimburse if it was the same anesthesiologist who did the original case. That doesn't make sense to me that a different anesthesiologist who was forced to do a bring back case while they were on call would get nothing (in an eat what you kill model).

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[UscGhost]

As far as I know, it's billed as a separate case. So no change for you. Other than maybe a different procedure CPT code

 

[chessknt]

How does the reimbursement work for return to OR cases secondary to a surgical complication (same day/within 24 hours)? I tried to search this on the medical coding forum but couldn't get a clear answer in regards to our specialty. I think for surgeons, if it's due to a complication due to surgery it's a reduced rate (70-90% of total) based on this site https://www.aapc.com/blog/24234-choose-which-modifier-58-78-or-79/

Does it matter with regards to anesthesia(same vs different anesthesiologist)? The modifier 78 only pertained to "same physician." A senior in my group said it would only reimburse if it was the same anesthesiologist who did the original case. That doesn't make sense to me that a different anesthesiologist who was forced to do a bring back case while they were on call would get nothing (in an eat what you kill model).

A lot of billing isn't fair to be frank. In the ICU if the night guy admits someone and bills 35 mins cc time I have to do 70 minutes of work to be able to bill a code. If I do a central line and an aline at the same time I only get paid 50% for the second procedure. If I do a bronch and biopsy 5 lymph nodes I get paid the same as if I biopsy 3 (which for Medicare is about $20 more than biopsying 1).

You guys actually have it pretty good--you are paid by time alone in lawyer level chunks with a bonus up front. Cc time is split in to 103 then 30 minutes blocks. I can spend an hour trying to control bleeding in an airway and get paid exactly the same as if I spent 2 minutes.

 

[teacher2md]

It depends on whether the surgeon blames the complication on anesthesia. The AF “Anesthesia’s Fault” modifier means that you don’t get any base units.

 

[jwk]

A lot of billing isn't fair to be frank. In the ICU if the night guy admits someone and bills 35 mins cc time I have to do 70 minutes of work to be able to bill a code. If I do a central line and an aline at the same time I only get paid 50% for the second procedure. If I do a bronch and biopsy 5 lymph nodes I get paid the same as if I biopsy 3 (which for Medicare is about $20 more than biopsying 1).

You guys actually have it pretty good--you are paid by time alone in lawyer level chunks with a bonus up front. Cc time is split in to 103 then 30 minutes blocks. I can spend an hour trying to control bleeding in an airway and get paid exactly the same as if I spent 2 minutes.

Lawyer level chunks? Medicare is $84/hr in my area.

 

[tweekin19]

It depends on whether the surgeon blames the complication on anesthesia. The AF “Anesthesia’s Fault” modifier means that you don’t get any base units.

Isn't everything anesthesia's fault though? But I was wondering about roll back surgical hematoma specifically. We have a new surgeon we work with who does large volume cases and I feel like we've had a handful of rollback hematoma cases.

Also curious if some complication for a postoperative ASC patient who has to go to the hospital and a different surgery/Anesthesia team has to go back. It's a surgical complication but different provider. Wonder if the surgeon fixing the problem gets paid in full when they didn't operate originally.

 

[nimbus]

Isn't everything anesthesia's fault though? But I was wondering about roll back surgical hematoma specifically. We have a new surgeon we work with who does large volume cases and I feel like we've had a handful of rollback hematoma cases.

Also curious if some complication for a postoperative ASC patient who has to go to the hospital and a different surgery/Anesthesia team has to go back. It's a surgical complication but different provider. Wonder if the surgeon fixing the problem gets paid in full when they didn't operate originally.

Yes you get paid. 358xx codes all pay pretty well….8-15 base units.

 

[centdoc]

Usually, Medicare will only pay for one procedure per day. For example, if the pt has an MRI with anesthesia, then later that day gets a cervical fusion, Medicare will only pay for either the MRI or fusion. If you know that in advance, you would generally submit the fusion since it results in higher units.

 

[Lecithin5]

Usually, Medicare will only pay for one procedure per day. For example, if the pt has an MRI with anesthesia, then later that day gets a cervical fusion, Medicare will only pay for either the MRI or fusion. If you know that in advance, you would generally submit the fusion since it results in higher units.

So bizarre. Did I not do 2 cases? Why don’t I get paid for that?

But I guess surgeons deal with this crap all the time. The whole post-surgical global period where care is free…

 

[UscGhost]

Usually, Medicare will only pay for one procedure per day. For example, if the pt has an MRI with anesthesia, then later that day gets a cervical fusion, Medicare will only pay for either the MRI or fusion. If you know that in advance, you would generally submit the fusion since it results in higher units.

I believe that's only the case if it's multiple prociduring the same patient encounter.

So if they are separate cases at separate times, then they pay both

 

[nimbus]

I believe that's only the case if it's multiple prociduring the same patient encounter.

So if they are separate cases at separate times, then they pay both

Yes. For example CABG followed by chest exploration for postop hemorrhage 4 hrs later. 2 separate cases. Both are paid.