# repair of wound dehiscence



## CatchTheWind

Is repair of wound dehiscence ever payable during the global period?  

If so, would you use one of the wound dehiscence codes (which seem to be more suitable for major surgeries) or the regular repair codes?

What modifier would you use?


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## jwiles66

This would be payable when the patient is in a global with a modifier and we use modifier 78 in this case.  The CPT code would depend on how extensive it is if is is superficial or more complicate.   We use either CPT code 12020 or 13160.  Hope this helps.


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## CatchTheWind

Thanks!  But, per the Medicare Learning Network's "Global Surgery Fact Sheet, "an OR, [for the purpose of using modifier 78 for "unplanned return to the operating/procedure room"] is defined as a place of service specifically equipped and staffed for the sole purpose of performing procedures. The term includes a cardiac catheterization suite, a laser suite, and an endoscopy suite. It does not include a patient?s room, a minor treatment room, a recovery room, or an intensive care unit (unless the patient?s condition was so critical there would be insufficient time for transportation to an OR).

So that leads me back to the original question of whether there is any way that treating a wound dehiscence can be payable?


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## BenCrocker

So where was it treated?


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## CatchTheWind

In a dermatology office.


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## CatchTheWind

I've done some more research, but it's only left me more confused.  

On one hand, I discovered that 12020 does not bundle with excisions or repairs, which means it should be payable during the global without any modifier.  (This is not the case with 13160.)

On the other hand, in the same "Global Surgery Fact Sheet" that I referred to before, CMS specifically says that "all additional medical or surgical services required of the surgeon during the post-operative period of the surgery because of complications, which do not require additional trips to the operating room" are included in the global surgery payment.  I would think that this seems to pretty clearly exclude payment for treatment of wound dehiscence, no?


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## jwiles66

Modifier 78 can be used even in the office for procedures.  It states unplanned return to or/procedure room.  We use this alot in this case for our surgeons in the same instance.   The 12020 will refquire a modifier if on a different day and in a global, it would not be bundled if the procedure were done together on the same day.   Hope this helps.


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## CatchTheWind

Modifier 78 cannot be used in the office, per CMS.

Per CMS, this modifier can only be used if the patient is brought back to a room that is "specifically equipped and staffed for the sole purpose of performing procedures. The term includes a cardiac catheterization suite, a laser suite, and an endoscopy suite. It does not include a... minor treatment room."

The key term here is "minor treatment room."  The "surgery room" in a dermatology office is what CMS is calling a "minor treatment room," for which modifier 78 does not apply.


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## jwiles66

I guess in our case we can use it because or office has an actual surgery suite where surgeries are done.


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## drampas3418

we use a modifier 58


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## JesseL

if it does need a modifier I'd go with modifier 58 since it's related to the original procedure.


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