Coding For A Hospital Consult During the Global Period

Eight days after a transmetatarsal amputation, your patient is admitted to the hospital for dehiscence and cellulitis at the closure site. You follow this patient in the hospital with multiple visits but do not perform surgery. Can you code for these visits?

The only evaluation and management (E/M) modifier option during a global period is the 24 modifier, which refers to “Unrelated evaluation and management service by the same physician or other qualified health care professional during a postoperative period.” 

The pathology for which you perform the E/M must be “unrelated” to the procedure for which the patient is in the global period. Some may interpret this to mean a different diagnosis, like wound dehiscence or post-op infection, but that is an incorrect interpretation. The pathology must be unrelated. Therefore, unfortunately, these hospital visits would fall under the global period associated with the amputation.

Dr. Lehrman is a consultant to the APMA Health Policy and Practice Department, serves as an expert panelist on Codingline, and is a Fellow of the American Academy of Podiatric Practice Management (AAPPM). Follow him on Twitter @DrLehrman.

References

1. American Medical Association. CPT 2018 Professional Edition.

2. APMA Coding Resource Center. Available at  https://www.apmacodingrc.org/home.asp .