Seroma after Breast Reconstruction

Question:

During the post-operative global period following breast reconstruction the patient presents with a seroma. Can I bill for the seroma excision and also bill for an office visit since it is a new problem?

Answer:

Medicare says treating the patient for issues related to the procedure, such as a seroma, are not separately payable unless they require a return to the operating room (modifier 78). There is not a modifier for “return to the office to treat a surgical complication.”

Check your other payors for their rules – in the absence of a specific payor rule allowing payment for treating complications in the office, we typically recommend you not bill. And, don’t forget, if you bill then the patient will have a co-pay.

*This response is based on the best information available as of 06/11/20.