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Orthopedic Coding Alert

Reader Question:

Do Not Always Claim the Hospital Admission

Question: How would you handle a hospital admission during the post operative period as far as a charge is concerned?  Patient came in to the office with cellulitis/abscess, and after examination was admitted to the hospital.  What code do we enter for the encounter?Ohio SubscriberAnswer: You will need to confirm whether or not the cellulitis is located at the pelvic site. If your patient is a Medicare patient or has an insurance that follows CMS Surgical Package guidelines, you cannot bill for the admission, as it would be included in your postoperative care. CMS does not permit billing for postoperative complications.If however, your patient's insurance follows CPT® Surgical Package guidelines, you might be able to bill for the admission since complications are not included in the surgical package.The CPT® Surgical Package Definition follows:"The services provided by the physician to any patient by their very nature are variable. The CPT® codes [...]


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