“I’m in an ongoing debate with my biller. I have always been under the impression that when billing for infected, ingrown nails that local anesthetics were considered part of the procedure. My biller thinks I can charge for them. What is correct?"
When billing for infected, ingrown nails that require a local anesthetic injection or for that matter, any procedure that requires a local anesthetic injection and the injection is administered by the surgeon, the injection IS part of the procedure and is not separately reimbursable. This is dictated by the Global Policy for Minor Surgeries and the Global Policy for Major Surgeries.
Minor Surgery: Any CPT code that has a Global Period of “0” or “10” days is classified as a Minor Surgical Procedure.
Major Surgery: Any CPT code that has a Global Period of “90” days is classified as a Major Surgical Procedure.
Global Policy for Minor Surgeries:
Any E/M service performed on the same day, as a Minor Surgery is included in the Surgery fee.
An initial (visit) E/M service may be billed using the -25 Modifier on the E/M code.
ALL intra-operative services such as a local anesthesia, injections, dressings, casts, splints, post-op shoes, wires, pins, supplies, etc. that are a necessary part of a surgical procedure are included in the surgery fee.
Any and all medical and surgical services related to complications, which do not require a return to the operating room or procedure room, are included in the surgery fee.
All post-op visits, during the 0 or 10 day follow-up period that are related to recovery from the surgery are included in the surgery fee.
Any post-op pain management services directly related to the surgery are included in the surgery fee.
All hospital admission and discharge reports, including the surgeon’s H & P are included in the surgery fee.
Any anesthesia (local, regional, and general) provided by the surgeon is included in the surgery fee.
You may bill for any pre-operative consultations by a non-surgeon.
You may bill for any surgical procedure that requires a return to the operating room or procedure room (use Modifier -78 on the surgical code).
You may bill for any post-op injectable drugs (materials only) by using the appropriate J code. Bill to MAC.
You may bill for any splint or casting supplies used post-op by using the Q codes as appropriate. Bill to MAC.
You may bill for any devices for fractures or dislocations used post-op (ie CAM WALKER) by using the appropriate L code. Bill to DMERC.
The eighth item above provides you with the answer to the posted question.
Global Policy for Major Surgeries:
The preoperative visit on the same day or one day prior to the day of surgery is included in the surgery fee.
An initial (visit) E/M service (99202-99205, 99324-99328, 99281-99285) may be billed using the -57 Modifier on the E/M code.
You may bill a separately identifiable procedure on the same day by using the -57 Modifier on the E/M code.
For a major surgery, you may use the -57 Modifier to bill for the service to decide to perform the surgery, if it occurs the day before or day of major surgery.
If the decision to perform surgery is made at the time of a consultation, you may bill the E/M code with the -57 Modifier.
ALL intra-operative services such as a local anesthesia, injections, dressings, casts, splints, post-op shoes, wires, pins, supplies, etc. that are a necessary part of a surgical procedure are included in the surgery fee.
Any and all medical and surgical services related to complications, which do not require a return to the operating room or procedure room, are included in the surgery fee.
All post-op visits, during the 90 day follow-up period that are related to recovery from the surgery are included in the surgery fee.
Any post-op pain management services directly related to the surgery are included in the surgery fee.
All hospital admission and discharge reports, including the surgeon’s H & P are included in the surgery fee.
Any anesthesia (local, regional, and general) provided by the surgeon is included in the surgery fee.
You may bill for any pre-operative consultations by a non-surgeon.
You may bill for any surgical procedure that requires a return to the operating room or procedure room (use Modifier -78 on the surgical code).
You may bill for any post-op injectable drugs (materials only) by using the appropriate J code. Bill to MAC.
You may bill for any splint or casting supplies used post-op by using the Q codes as appropriate. Bill to MAC.
You may bill for any devices for fractures or dislocations used post-op (ie CAM WALKER) by using the appropriate L code. Bill to DMERC.
The tenth item above provides you with the answer to the posted question.
This is my opinion.
Michael G. Warshaw, DPM, CPC
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Dr. Michael G. Warshaw
2027 Bayside Avenue
Mount Dora, Florida 32757
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