Second Surgery Coding: Tips for Modifier 58, 78 Success
Posted on 19. Jan, 2010 by sanjay.aikat in Hot Coding Topics
Don’t let ‘unplanned’ lead to ‘unpaid.’
The next time a patient takes an extra trip to the operating room, don’t let the added service throw your coding off track. Keep these tips in mind to know when to assign modifier 78 – or something else.
Check for Surprise Versus Planned
Two modifiers pertain to follow-up trips to the OR, but knowing the basic difference helps you choose the right one:
• Modifier 58 (Staged or related procedure or service by the same physician during the postoperative period) represents an expected return to the OR. This could be because the original surgery normally is performed during multiple sessions or the follow-up is more extensive than the original procedure. “The patient’s condition dictates the additional service or the service was planned prior to the original surgery,” explains Linda Parks, office manager for Herrin Family Medicine in Lilburn, Ga. You can also report modifier 58 for non-OR sessions, such as planned therapy following surgery.
• Modifier 78 (Unplanned return to the operating/ procedure room by the same physician following initial procedure for a related procedure during the postoperative period) “would be used when a complication arises after surgery and the patient has to be returned to the OR,” Parks says. The complications, rather than the patient’s condition, call for a follow-up procedure related to the original surgery. Modifier 78 is the payer’s tip-off that the new procedure was related to the original surgery.
Consider these two examples from Kathy Nelson, CPC, a coder with Fletcher Allen Health Care in Burlington, Vt.:
• Your surgeon sees a patient in the emergency room who has multiple trauma injuries. He reduces a fracture and applies an external fixation system with the intention of taking the patient to the operating room later for more definitive treatment....
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Laura Capelo
20. Jan, 2010
If a patient has a 90 day gloabal procedure and develops a severe wound infection (due to patient with poor hygiene for example) at the surgical site requiring the patient to be returned to the operating room would this be a -78 modifier? Is this wound infection considered a complication of the surgery?