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Recovery Charges


Question

Following routine surgery of hernia or appendix for example,no unplanned outcomes requiring observation occur. However, patient stays overnight till next morning. No one on one nursing, just standard recovery. Vitals checked, food tolerated, urination, all observed. What charges are appropriate from the end of surgery recovery period(4-6 hours) till discharge?

Answer

Same day surgery patients, as you have pointed out, are expected to be discharged within the 4-6 hour post operative period.  Patients who are kept overnight that do not meet medical necessity for observation care would appear to be kept for patient or physician convenience which would not be a covered service.  Occasionally I have seen a facility try to bill this either under the surgery or recovery room revenue code however, whenever I do, I recommend that that the facility discuss the appropriateness of this with their fiscal intermediary along with the proper revenue code to charge it under.  Other facilities have set up an extended recovery room charge with a $0 charge just to keep track of the hours spent providing services to these patients.

Disclaimer: All articles intended for general consumption only and not as a recommendation for a specific situation. Readers should consult an official source (AHA, AMA, etc.) or a qualified attorney for specific legal guidance.
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