any fee difference from Medicare from the surgery incision?

[janesu]

What is the name of your state? California

Could a surgical doctor collect more fee from Medicare if there is a larger incision on the surgery? My mom had a G-tube sugery. I found out she had a large incision on her abdomen for the g-tube surgey. This is not commonly done this way. The incision was done without the informed consent of my mother & family members.

 

[ecmst12]

No, payment has nothing to do with the size of the incision. It depends on the procedure performed, designated by the codes that are billed with. If your mother consented to the procedure, then she consented to the procedure. Unless you're talking about a surgery that was supposed to be laparoscopic but had to be converted to an open procedure. If this was done, there was a medical reason for it and it most likely would have been something that happened or was discovered after the surgery was began and your mother was unconscious. Therefore there was no way (and no need) to get a separate consent. There is always the possibilty/risk that it won't be possible to successfully complete a procedure laparoscopically and a full incision will have to be made; that's part of what's consented to in the original consent. In a case like that, the procedure that would get billed would be the open one, but whether there's a difference in fees would depend on what it is and would in most cases not be significant. This would not be done simply to be able to get a few more dollars from Medicare.

 

[panzertanker]

No, payment has nothing to do with the size of the incision. It depends on the procedure performed, designated by the codes that are billed with. If your mother consented to the procedure, then she consented to the procedure. Unless you're talking about a surgery that was supposed to be laparoscopic but had to be converted to an open procedure. If this was done, there was a medical reason for it and it most likely would have been something that happened or was discovered after the surgery was began and your mother was unconscious. Therefore there was no way (and no need) to get a separate consent. There is always the possibilty/risk that it won't be possible to successfully complete a procedure laparoscopically and a full incision will have to be made; that's part of what's consented to in the original consent. In a case like that, the procedure that would get billed would be the open one, but whether there's a difference in fees would depend on what it is and would in most cases not be significant. This would not be done simply to be able to get a few more dollars from Medicare.

The one question I would have about that would be what about fee scale differences based on the difficulty level of the procedure?

Ex: I do a single layer wound closure vs. multi-layer.
Different CPT, different ICD-9 = higher reimbursement.

Would that apply to this situation as well ecmst12?

 

[ecmst12]

I am not a certified coder or anything like that, but I'm familiar with CPT codes. I've never seen the same surgical procedure have different codes for different types of closures. A single vs. double layer wound closure would be just a closure for a laceration or something without an associated surgery right? That's what it sounds like. So in that case the fee amounts may be different but still probably not VASTLY different. But I don't think that would apply to OP's situation.

OP's situation was EITHER a laparoscopic surgery converted to an open surgery, in which case a different CPT code would be billed but could end up being either more OR less expensive depending on the procedure, and the fees involved would have nothing to do with the decision to change the type of surgery....

OR OP's mother just ended up with a bigger scar/incision then she was expecting in which case no, the amount that medicare reimburses won't change because of that, and most likely the larger incision was necessary to complete the procedure.

But when you have a complicated surgery, you don't bill Medicare separately for the closure, the whole thing is paid at one rate under the code for the main procedure, at least as far as the doctor's bill goes (facility/pathology/anesthesia/etc bills are a whole other can of worms!).