The following guidelines should be followed for procedures performed within the normal post-operative period following definitive surgery in treatment of the same condition:

1. Payment may be made for procedures performed to assist the patient in recovery such as hyperalimentation, cutdown, CVP catheter insertion or the like (see codes 36555-36556, 36568-36569, 36580, 36584, 44015).
   
   
2. Payment may be made for a cystoscopy when performed subsequent to chemotherapy for malignancies.
   
   
3. Payment may be made for procedures reported by a physician other than the operating surgeon, his surgical associate or surgical assistant in the treatment of post-operative complications.
   
   
4. Payment may be made for removal of buried wire, pin, screw, metal band, rod, nail or plate, deep (procedure code 20680).
   
   
5. Payment may not be made for the following surgeries unless the doctor documents on the claim that it was necessary to return the patient to the operating room:
   
   
   • I & D of abscess (surgical site)(10180)
   • Debridement or cautery (surgical site)
   • Arthrocentesis (following joint surgery)(20600, 20605, 20610)
   • Diagnostic endoscopic procedures (e.g., 31231, 31233, 31235)
   • Removal of buried wire, pin, screw, metal band, rod, nail or plate, superficial (20670)
   • Removal of catheter (e.g., Hickman, Broviac, bladder, etc.)
     
     
6. Removal of sutures by any other doctor (see Medical Policy Bulletin S-61).
   
   
7. Coverage for physical medicine performed during the postoperative period is determined according to individual or group customer benefits.
   
   
8. Unusual circumstances not addressed above should be reviewed on the basis of individual consideration.

Requests for review of services denied as a result of #5 should be referred for medical review if the doctor subsequently provides additional information.