4 m/o patient with dx of Hirschprung’s disease (Q43.1) s/p surgery on 10/9/17 for complete proctectomy w/ pull through and anastomosis (45120), returned to hospital on 10/26/17 with dx of enterocolitis (K52.9). The patient is still in 30 day Medicaid global at this time. Would the hospital visits related to the 10/26/17 admission be considered related to the surgery performed on 10/9 or unrelated? The enterocolitis is certainly a complication related to the initial diagnosis as pt’s with Hirschprung’s disease frequently do have enterocolitis but nothing in the notes indicate that the enterocolitis is a complication of the procedure itself. I am torn between making the visits post-op visits and no charge vs. whether it would be appropriate to bill these hospital visits with a 24 modifier as unrelated to the original procedure. According to SC Medicaid manual, “Complications or services rendered for a diagnostic reason unrelated to the surgery may be billed with a separate examination code if the primary diagnosis reflects a different reason for the service. To report postoperative visits unrelated to surgery, submit the visit code(s) with modifier 24 or 25. The medical record must substantiate that a visit(s) was justified outside of the surgical package limitation.”

Any insight would be appreciated!

Samantha