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.
