Payment for surgical procedures generally includes:

• one (1) day of inpatient preoperative care;
• intraoperative care, including the surgical procedure;
• postoperative care, including services for complications which don't require a return to the operating room.

Typically, postoperative care consists of visits to examine the patient and to evaluate recovery. Subsequent surgeries are not part of the postoperative care and are separately reimbursable, with the following exceptions (these procedures are only payable during the postoperative period if 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.)

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

Separate payment may be made for:

• procedures performed to assist the patient in recovery, such as hyperalimentation, cutdown, CVP catheter insertion, etc. (e.g., codes 36555-36556, 36568-36569, 36580, 36584, 44015);
• removal of buried wire, pin, screw, metal band, rod, nail or plate, deep (code 20680);
• physical medicine, in accordance with the member's benefit coverage;
• procedures reported by a physician other than the operating surgeon, surgical associate, or assistant surgeon in the treatment of postoperative complications.

Unusual circumstances not addressed above should be reviewed on the basis of individual consideration.

NOTE:

See Medical Policy Bulletin G-10 for information on medical care with surgery.

See Medical Policy Bulletin V-28 for information on inpatient preoperative care.

See Medical Policy Bulletin S-61 for removal of sutures by any other doctor.

This medical policy may not apply to FEP. Medical policy is not an authorization, certification, explanation of benefits, or a contract. Benefits are determined by the Federal Employee Program.