September 6, 2018
I am being told that treating a post-tonsillectomy bleed in the ED with local anesthesia and silver nitrate will not be paid. Is it true that the only code that would be reimbursed is bringing the patient back to the OR?
Medicare says that the tonsillectomy’s 90-day postoperative period includes treatment of any complications (e.g., bleed) unless the patient is taken to the operating room. So if this is a patient covered by Medicare, or Medicare payor, then the ED service would not be billed. You’ll have to check your non-Medicare plans to determine their postoperative global period policy and whether services provided in the ED related to the surgical procedure are separately payable.
*This response is based on the best information available as of 09/06/18.